Healthcare Provider Details

I. General information

NPI: 1790827905
Provider Name (Legal Business Name): CHILDRENS HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVENUE SOUTH CHILDRENS HOSPITALS AND CLINICS HEARING AIDS
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

5901 LINCOLN DRIVE, CBC-2-REV/PE
EDINA MN
55436-1611
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6709
  • Fax:
Mailing address:
  • Phone: 952-992-5398
  • Fax: 952-992-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number334716
License Number StateMN

VIII. Authorized Official

Name: MARC H GORELICK
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 612-813-8031