Provider Demographics
NPI:1356475313
Name:CHILDREN'S HOSPITAL, CHADWICK CENTER FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL, CHADWICK CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STERN-ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-420-5611
Mailing Address - Street 1:1261 3RD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3262
Mailing Address - Country:US
Mailing Address - Phone:619-420-5611
Mailing Address - Fax:619-420-5531
Practice Address - Street 1:1261 3RD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3262
Practice Address - Country:US
Practice Address - Phone:619-420-5611
Practice Address - Fax:619-420-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16941282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren