Healthcare Provider Details

I. General information

NPI: 1922196138
Provider Name (Legal Business Name): LARABIDA CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E 65TH STREET AT LAKE MICHIGAN
CHICAGO IL
60649-1395
US

IV. Provider business mailing address

E 65TH STREET AT LAKE MICHIGAN
CHICAGO IL
60649-1395
US

V. Phone/Fax

Practice location:
  • Phone: 773-363-6700
  • Fax: 773-363-6527
Mailing address:
  • Phone: 773-363-6700
  • Fax: 773-363-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number0003012
License Number StateIL

VIII. Authorized Official

Name: PAULA K VAUDES
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 773-363-6700