Provider Demographics
NPI:1710775549
Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-636-5047
Mailing Address - Street 1:3341 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5642 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3114
Practice Address - Country:US
Practice Address - Phone:513-636-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility