NPIMap

Organization Active NPI

Columbus Hospital Ltach LLC

  • Long Term Care Hospital
  • Newark, NJ
National Provider Identifier
1508203878
Registry record updated Mar 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
24009 Issued in NJ
Legal business name
COLUMBUS HOSPITAL LTACH LLC
Practice address
495 N 13TH St
Newark, NJ 07107-1317
Phone
(973) 587-7777
Fax
(973) 587-7830
NPI assigned
May 28, 2013
Organization subpart
Yes
Parent organization
COLUMBUS HOSPITAL LTACH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Burguillos
Title
Cfo
Phone
(973) 587-7707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 24009 NJ Primary
General Acute Care Hospital 282N00000X 1396 NJ

Addresses

Primary practice location

495 N 13TH St
Newark, NJ 07107-1317

Mailing address

495 N 13TH St
Newark, NJ 07107-1317
Phone (973) 497-7770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110504000335 NJ Part A Provider - Hospital 4587797857 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newark, NJ

Hospital certification: CCN 312024

Legal name
COLUMBUS HOSPITAL LTACH, LLC
Doing business as
SILVER LAKE HOSPITAL LTACH
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Sep 14, 2010
Last certification
Jun 30, 2022
Beds
63
Ownership / control type
Church
Organization structure
LLCProprietary
Incorporated
Mar 15, 2010 in NJ
Enrollment address
495 North 13TH Street
Newark, NJ 71071317
Other Hospital Practice Location
Hospital subgroups
Long-term

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Silver Lake Hospital LtachCCN 312024
Type
Long-term
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Silver Lake Hospital LtachCCN 312024
Ownership
Non-profit
Certified
Sep 14, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Beds
63

National Provider Directory

National Provider Directory
Part of
Columbus Hospital Ltach LLC

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Richard Z Lipsky Individual 5% Or Greater Direct Ownership Interest Apr 1, 2011
Linda Laforgia Individual Corporate Director Nov 1, 2014
W-2 Managing Employee Nov 1, 2014
Columbus Hospital Ltach, LLC Organization, Newark, NJ LLC Operational/Managerial Control Oct 1, 2023
Edward a Cienki Individual Corporate DirectorPresident & Coo Oct 1, 2023
W-2 Managing EmployeePresident & Coo Oct 1, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394755200000",
    "number": "1508203878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 N 13TH ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071071317",
            "telephone_number": "973-497-7770",
            "fax_number": "973-497-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 N 13TH ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071071317",
            "telephone_number": "973-587-7777",
            "fax_number": "973-587-7830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBUS HOSPITAL LTACH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBUS HOSPITAL LTACH LLC",
        "enumeration_date": "2013-05-28",
        "last_updated": "2014-03-14",
        "status": "A",
        "authorized_official_last_name": "BURGUILLOS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "973-587-7707"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NJ",
            "license": "24009",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NJ",
            "license": "1396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.