Provider Demographics
NPI:1689867038
Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:510-428-3467
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3500
Mailing Address - Fax:
Practice Address - Street 1:5275 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1032
Practice Address - Country:US
Practice Address - Phone:510-428-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL & RESEARCH CENTER AT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7087273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid