Provider Demographics
NPI:1316218605
Name:LUCILE PACKARD CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:LUCILE PACKARD CHILDREN'S HOSPITAL
Other - Org Name:LPCH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINZELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-498-2738
Mailing Address - Street 1:321 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3500
Mailing Address - Country:US
Mailing Address - Phone:650-497-0245
Mailing Address - Fax:650-462-0225
Practice Address - Street 1:321 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3500
Practice Address - Country:US
Practice Address - Phone:650-497-0245
Practice Address - Fax:650-462-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5646282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA053305Medicaid