Provider Demographics
NPI:1003961251
Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Other - Org Name:CHILDREN'S HOSP MED CTR OF NO CALIFORNIA
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:510-428-3467
Mailing Address - Street 1:PO BOX 742403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2403
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-428-3840
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-428-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000015282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40611FMedicaid
CA053301OtherPTAN
CAHSC00611FMedicaid
CAZZR00611FMedicaid
CAFHC80242FMedicaid
CAFHC80242FMedicaid
CA053301OtherPTAN