Provider Demographics
NPI:1093852436
Name:CRIPPLED CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:CRIPPLED CHILDREN'S HOSPITAL
Other - Org Name:CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-321-7474
Mailing Address - Street 1:2924 BROOK RD
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1215
Mailing Address - Country:US
Mailing Address - Phone:804-321-7474
Mailing Address - Fax:804-321-2728
Practice Address - Street 1:10530 SPOTSYLVANIA AVE SUITE 102
Practice Address - Street 2:CHILDREN'S HOSPITAL THERAPY CENTER
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-891-4485
Practice Address - Fax:540-891-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty