1417016825 NPI number — KIDSPEACE CHILDREN'S HOSPITAL, INC.

Table of content: (NPI 1417016825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417016825 NPI number — KIDSPEACE CHILDREN'S HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDSPEACE CHILDREN'S HOSPITAL, 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:
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:
1417016825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4085 INDEPENDENCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHNECKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18078-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-854-3123
Provider Business Mailing Address Fax Number:
610-799-8318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 KIDSPEACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18069-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-854-3123
Provider Business Practice Location Address Fax Number:
610-799-8801
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLACK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
610-799-8405

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  234200 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0002392000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418657500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5061679 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417016825 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003134400 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417016825 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02103886 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417016825 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019373900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100728370-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417016825 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417016825 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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