Provider Demographics
NPI:1508937277
Name:CHILDRENS HOSPITAL HOMECARE
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-353-7125
Mailing Address - Street 1:7555 N DEL MAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6860
Mailing Address - Country:US
Mailing Address - Phone:559-353-7125
Mailing Address - Fax:559-353-7462
Practice Address - Street 1:7555 N DEL MAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6860
Practice Address - Country:US
Practice Address - Phone:559-353-7125
Practice Address - Fax:559-353-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44810332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA448100Medicaid