Provider Demographics
NPI:1770855157
Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Other - Org Name:CHKD HEALTH CENTER AT LIGHTFOOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-8565
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-9647
Mailing Address - Fax:757-668-8929
Practice Address - Street 1:119 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-668-9688
Practice Address - Fax:757-668-8848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D1092962291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory