Healthcare Provider Details

I. General information

NPI: 1124163910
Provider Name (Legal Business Name): KIDSPEACE CHILDREN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BROADWAY
BETHLEHEM PA
18015-3904
US

IV. Provider business mailing address

4085 INDEPENDENCE DR
SCHNECKSVILLE PA
18078
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-8222
  • Fax: 610-867-2233
Mailing address:
  • Phone: 800-854-3123
  • Fax: 610-799-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL SLACK
Title or Position: CEO
Credential:
Phone: 610-799-8405