Provider Demographics
NPI:1275612673
Name:VALLEY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:VALLEY CHILDREN'S HOSPITAL
Other - Org Name:VALLEY CHILDREN'S HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-353-7238
Mailing Address - Street 1:5085 E MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1964
Mailing Address - Country:US
Mailing Address - Phone:559-353-7125
Mailing Address - Fax:559-353-7460
Practice Address - Street 1:5085 E MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1964
Practice Address - Country:US
Practice Address - Phone:559-353-7125
Practice Address - Fax:559-353-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY448103336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA4481000Medicaid
CA00-3882OtherBLUE CROSS PROVIDER