Provider Demographics
NPI:1710091780
Name:LOS NINOS HOSPITAL INC
Entity Type:Organization
Organization Name:LOS NINOS HOSPITAL INC
Other - Org Name:LOS NINOS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-4231
Mailing Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7925
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:602-323-5988
Practice Address - Street 1:2303 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7827
Practice Address - Country:US
Practice Address - Phone:602-954-7311
Practice Address - Fax:602-954-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X, 3336S0011X
AZY0042303336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992397OtherPK
AZ155128Medicaid
AZ818552Medicaid
AZ544032Medicaid