Provider Demographics
NPI:1902270002
Name:CHILDREN'S HEALTH CARE
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO / COO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-688-3602
Mailing Address - Street 1:650 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2300
Mailing Address - Country:US
Mailing Address - Phone:650-688-3602
Mailing Address - Fax:
Practice Address - Street 1:4176 LICK MILL BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3585
Practice Address - Country:US
Practice Address - Phone:650-688-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health