Provider Demographics
NPI:1073628756
Name:CHILDREN'S HEALTHCARE CENTER
Entity Type:Organization
Organization Name:CHILDREN'S HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:330-797-9172
Mailing Address - Street 1:25 N CANFIELD NILES RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2328
Mailing Address - Country:US
Mailing Address - Phone:330-797-9172
Mailing Address - Fax:330-797-9174
Practice Address - Street 1:25 N CANFIELD NILES RD
Practice Address - Street 2:SUITE 160
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2328
Practice Address - Country:US
Practice Address - Phone:330-797-9172
Practice Address - Fax:330-797-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2456337Medicaid