Provider Demographics
NPI:1235209081
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:CHILDREN'S HOSPITAL HOME CARE
Other - Org Type:Doing Business As
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:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA748105251F00000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA60700OtherKEYSTONE MERCY HEALTH
PA1007709910113Medicaid
PA5932558OtherAETNA PPO
PA1007709910102Medicaid
PA0002936000OtherINDEPENDENCE BLUE CROSS
PA83467OtherAETNA HMO