Provider Demographics
NPI:1831298702
Name:CHILDREN'S HEALTH CARE
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH CARE
Other - Org Name:CHILDREN'S HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA LU
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-813-6129
Mailing Address - Street 1:5901 LINCOLN DRIVE, CBC-2-REV/PE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5691
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:952-992-5700
Practice Address - Fax:952-992-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN435247500Medicaid
24-7110Medicare PIN