Provider Demographics
NPI:1972847663
Name:PHOENIX CHILDREN'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:PHOENIX CHILDREN'S HOSPITAL, INC.
Other - Org Name:PHOENIX CHILDREN'S URGENT CARE CENTERS - NORTH WEST VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP, MANAGED CARE & PAYER STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:RAHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-933-3548
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:STE 116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:602-933-0003
Practice Address - Fax:602-933-6152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX CHILDREN'S HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH3107261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ778399Medicaid