Provider Demographics
NPI:1710058151
Name:VALLEY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VALLEY CHILDREN'S HOSPITAL
Other - Org Name:VALLEY CHILDREN'S HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-353-7090
Mailing Address - Street 1:5085 E MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1964
Mailing Address - Country:US
Mailing Address - Phone:559-353-7125
Mailing Address - Fax:559-353-7460
Practice Address - Street 1:5085 E MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1964
Practice Address - Country:US
Practice Address - Phone:559-353-7125
Practice Address - Fax:559-353-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000416251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70273FMedicaid