Healthcare Provider Details

I. General information

NPI: 1144317355
Provider Name (Legal Business Name): LOS NINOS HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 E. SOUTH MOUNTAIN AVENUE
PHOENIX AZ
85042
US

IV. Provider business mailing address

1402 E. SOUTH MOUNTAIN AVENUE
PHOENIX AZ
85042
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-4231
  • Fax: 602-323-5988
Mailing address:
  • Phone: 602-243-4231
  • Fax: 602-323-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA3379
License Number StateAZ

VIII. Authorized Official

Name: BARBARA NEWPORT
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 602-243-4231