Healthcare Provider Details

I. General information

NPI: 1235226440
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 E. THOMAS RD
PHOENIX AZ
85016
US

IV. Provider business mailing address

1402 E. SOUTH MOUNTAIN AVENUE
PHOENIX AZ
85042
US

V. Phone/Fax

Practice location:
  • Phone: 902-954-7311
  • Fax: 902-954-7355
Mailing address:
  • Phone: 602-243-4231
  • Fax: 602-323-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberSHO188
License Number StateAZ

VIII. Authorized Official

Name: DALE NORMAN SKURDAHL
Title or Position: CHIEF OPERATING OFFICER-M.S.
Credential:
Phone: 602-243-4231