Provider Demographics
NPI:1225715378
Name:THE CHILDRENS HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:THE CHILDRENS HOSPITAL OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:GRACIA
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-6022
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:215-590-2897
Mailing Address - Fax:484-324-7706
Practice Address - Street 1:800 HERITAGE DR STE 820
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9220
Practice Address - Country:US
Practice Address - Phone:610-326-8660
Practice Address - Fax:610-326-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910131Medicaid