Provider Demographics
NPI:1831639400
Name:CHILDREN'S HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-228-2402
Mailing Address - Street 1:3710 GRANDY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6112
Mailing Address - Country:US
Mailing Address - Phone:904-398-5561
Mailing Address - Fax:904-398-1460
Practice Address - Street 1:3710 GRANDY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6112
Practice Address - Country:US
Practice Address - Phone:904-398-5561
Practice Address - Fax:904-398-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370220100Medicaid
FL044852400Medicaid
FL013036900Medicaid
FL271799900Medicaid