Provider Demographics
NPI:1629163878
Name:LOS NINOS HOSPITAL INC
Entity Type:Organization
Organization Name:LOS NINOS HOSPITAL INC
Other - Org Name:LOS NINOS HOME MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-4231
Mailing Address - Street 1:1402 E. SOUTH MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:602-323-5988
Practice Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7925
Practice Address - Country:US
Practice Address - Phone:602-424-9880
Practice Address - Fax:602-424-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ488779Medicaid
AZ4406880001Medicare NSC