Provider Demographics
NPI:1164799789
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity Type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:SHRINERS HOSPITALS FOR CHILDREN-ERIE OUTPATIENT SPECIALTY CARE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-875-8700
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCK BOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:1645 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5007
Practice Address - Country:US
Practice Address - Phone:814-875-8700
Practice Address - Fax:814-875-8756
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHRINERS HOSPITALS FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-28
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation