Provider Demographics
NPI:1255357836
Name:CHILDREN HEALTHCARE CENTER
Entity type:Organization
Organization Name:CHILDREN HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:BURNETT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-864-0222
Mailing Address - Street 1:PO BOX 11787
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-1787
Mailing Address - Country:US
Mailing Address - Phone:256-864-0222
Mailing Address - Fax:256-864-0207
Practice Address - Street 1:1920 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1126
Practice Address - Country:US
Practice Address - Phone:256-864-0222
Practice Address - Fax:256-864-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF12811Medicare UPIN