Provider Demographics
NPI:1144317355
Name:LOS NINOS HOSPITAL INC
Entity type:Organization
Organization Name:LOS NINOS HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-4231
Mailing Address - Street 1:1402 E. SOUTH MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:602-323-5988
Practice Address - Street 1:1402 E. SOUTH MOUNTAIN AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042
Practice Address - Country:US
Practice Address - Phone:602-243-4231
Practice Address - Fax:602-323-5988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS NINOS HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-07
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3379251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ818552Medicaid
AZHHA3379OtherSTATE LICENSE
AZ03-7224Medicare ID - Type UnspecifiedMEDICARE LICENSE