Provider Demographics
NPI:1235226440
Name:LOS NINOS HOSPITAL INC.
Entity Type:Organization
Organization Name:LOS NINOS HOSPITAL INC.
Other - Org Name:LOS NINOS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER-M.S.
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SKURDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-4231
Mailing Address - Street 1:1402 E. SOUTH MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:602-323-5988
Practice Address - Street 1:2303 E. THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:902-954-7311
Practice Address - Fax:902-954-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSHO188284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSHO188OtherSTATE LICENSE
AZ155128Medicaid
AZ0D0898997OtherCLIA WAIVER
AZSHO188OtherSTATE LICENSE