1912004631 NPI number — CHILDRENS HEALTH CARE

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 1912004631 NPI number — CHILDRENS HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HEALTH CARE
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:
1912004631
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:
2910 CENTRE POINTE DRIVE
Provider Second Line Business Mailing Address:
35-121A
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-855-2109
Provider Business Mailing Address Fax Number:
651-855-2310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5950 CLEARWATER DRIVE
Provider Second Line Business Practice Location Address:
CHILDRENS HOSPITALS AND CLINICS COMMUNITY REHAB
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:
952-930-8630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASSMANN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
612-813-6113

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 435247511 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com