Provider Demographics
NPI:1942861349
Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CONTRACT DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-9647
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-9647
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-9647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004900961Medicaid