Healthcare Provider Details

I. General information

NPI: 1629161781
Provider Name (Legal Business Name): CHILDRENS HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N CHILDRENS HOSPITALS AND CLINICS OF MINNESOTA
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

5901 LINCOLN DRIVE, CBC-2-REV/PE CHILDREN'S HEALTH CARE
EDINA MN
55436
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6000
  • Fax:
Mailing address:
  • Phone: 952-992-5398
  • Fax: 952-992-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number331019
License Number StateMN

VIII. Authorized Official

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