Healthcare Provider Details

I. General information

NPI: 1841258589
Provider Name (Legal Business Name): CRIPPLED CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BROOK RD
RICHMOND VA
23220-1215
US

IV. Provider business mailing address

2924 BROOK RD
RICHMOND VA
23220-1215
US

V. Phone/Fax

Practice location:
  • Phone: 804-321-7474
  • Fax: 804-321-2728
Mailing address:
  • Phone: 804-321-7474
  • Fax: 804-321-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberH1627
License Number StateVA

VIII. Authorized Official

Name: MRS. LESLIE G. WYATT
Title or Position: PRESIDENT/CEO
Credential: RN, MS
Phone: 804-321-7474