Healthcare Provider Details

I. General information

NPI: 1609136092
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-1000
  • Fax: 330-543-3008
Mailing address:
  • Phone: 330-543-1000
  • Fax: 330-543-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2864137
License Number StateOH

VIII. Authorized Official

Name: MRS. ALICIA E. LAMANCUSA
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 330-543-8171