Provider Demographics
NPI:1457959744
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:WEST CHESTER HEALTHY WEIGHT
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-590-2897
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 MILES RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1950
Practice Address - Country:US
Practice Address - Phone:610-429-1100
Practice Address - Fax:610-429-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty