MEDICARE: CHILDREN'S HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy	262015	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048228	OTHER		PK

General Provider Information

NPI Number	:	1841332764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HEALTH CARE

Provider Business Mailing Address
First Line	:	PO BOX 860112
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CHICAGO AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4518
Country	:	US
Telephone Number	:	612-813-7206
Fax Number	:	612-813-7207

Authorized Official
Title or Position	:	SR. VP AND CHIEF FINANCIAL OFFICER
Name	:	BRENDA LU ALEXANDER MCCORMICK
Credential	:
Telephone Number	:	612-813-6129

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	10/31/2022

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Directions to “CHILDREN'S HEALTH CARE ” Practice Location

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