Provider Demographics
NPI:1609136092
Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Other - Org Name:AKRON CHILDREN'S HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAMANCUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-543-8171
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-1000
Mailing Address - Fax:330-543-3008
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-1000
Practice Address - Fax:330-543-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2864137251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864137Medicaid