NPIMap

Organization Active NPI

Kidspeace Children's Hospital, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Temple, PA
National Provider Identifier
1083048920
Registry record updated Aug 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
218750 Issued in PA
Legal business name
KIDSPEACE CHILDREN'S HOSPITAL, INC.
Practice address
704 Hay Rd
Temple, PA 19560-1843
Phone
(800) 854-3123
Fax
(610) 799-8318
NPI assigned
Aug 28, 2013
Last updated
Aug 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Slack
Title
Chief Operating Officer
Phone
(610) 799-8405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 218750 PA Primary

Addresses

Primary practice location

704 Hay Rd
Temple, PA 19560-1843

Mailing address

4085 Independence Dr
Schnecksville, PA 18078-2574
Phone (800) 854-3123

Other identifiers 1

IdentifierTypeStateIssuer
100728370-0016MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Kidspeace National Center Inc47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502409600000",
    "number": "1083048920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 INDEPENDENCE DR",
            "city": "SCHNECKSVILLE",
            "state": "PA",
            "postal_code": "180782574",
            "telephone_number": "800-854-3123",
            "fax_number": "610-799-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 HAY RD",
            "city": "TEMPLE",
            "state": "PA",
            "postal_code": "195601843",
            "telephone_number": "800-854-3123",
            "fax_number": "610-799-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSPEACE CHILDREN'S HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2017-08-11",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "610-799-8405",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "PA",
            "license": "218750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728370-0016",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.