Provider Demographics
NPI:1376618553
Name:RADY CHILDREN'S HOSPITAL - SAN DIEGO
Entity Type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL - SAN DIEGO
Other - Org Name:RADY CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAIN CARRITHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5019
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-576-5833
Mailing Address - Fax:858-576-8558
Practice Address - Street 1:3020 CHILDRENS WAY # MC5019
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-576-5833
Practice Address - Fax:858-576-8558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADY CHILDREN'S HOSPITAL - SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
CA0800000283140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC40009FMedicaid
CA053303Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER