Provider Demographics
NPI:1033289889
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR HOME CARE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:267-425-9089
Mailing Address - Street 1:3000 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2626
Mailing Address - Country:US
Mailing Address - Phone:800-866-1242
Mailing Address - Fax:610-992-1040
Practice Address - Street 1:3000 HORIZON DR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2626
Practice Address - Country:US
Practice Address - Phone:800-866-1242
Practice Address - Fax:610-992-1040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF PHILADELPHIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA748105332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6074715Medicaid
PA0002705000OtherINDEPENDENCE BLUE CROSS
PA1007709910003Medicaid
PA1070822OtherKEYSTONE MERCY
PAAETNA HMOOther3706539
PAAETNA PPOOther7750646
PA0868780001Medicare ID - Type UnspecifiedMEDICARE