Provider Demographics
NPI:1639278500
Name:CHILDRENS HEALTH CARE
Entity type:Organization
Organization Name:CHILDRENS HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORELICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-813-8031
Mailing Address - Street 1:5901 LINCOLN DRIVE, CBC-2-REV/PE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-992-5398
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:CHILDRENS HOSPITALS AND CLINICS - DURABLE MEDICAL EQUIP
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MN330291332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies