Healthcare Provider Details

I. General information

NPI: 1700982592
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

IV. Provider business mailing address

300 LONGWOOD AVE PATIENT FINANCIAL SERVICES ATN STEVEN NICOLL
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-4831
  • Fax: 617-730-0080
Mailing address:
  • Phone: 617-355-4831
  • Fax: 617-730-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number2139
License Number StateMA

VIII. Authorized Official

Name: MR. DAVID A KIRSHNER
Title or Position: SR VP FINANCE AND CFO
Credential:
Phone: 617-355-6881