Provider Demographics
NPI:1033235718
Name:RADY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:3020 CHILDREN'S WAY
Mailing Address - Street 2:MC 5014
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4282
Mailing Address - Country:US
Mailing Address - Phone:858-966-4011
Mailing Address - Fax:858-278-2365
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MC 5014
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-4011
Practice Address - Fax:858-278-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 146771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty