1255416681 NPI number — CHILDRENS HEALTH CARE SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255416681 NPI number — CHILDRENS HEALTH CARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HEALTH CARE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255416681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 LINCOLN DR
Provider Second Line Business Mailing Address:
CBC-2-REV/PE
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55436-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-992-5398
Provider Business Mailing Address Fax Number:
952-992-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6050 CLEARWATER DRIVE
Provider Second Line Business Practice Location Address:
CHILDRENS MINNETONKA
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-930-8600
Provider Business Practice Location Address Fax Number:
952-930-8650
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
BRENDA LU
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
SR. VP AND CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
612-813-6129

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 847979800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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