Basic Information
| Provider Information | |||||||||
| NPI: | 1538756077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDEN'S COMMUNITY CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11279 PERRY HWY STE 450 | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249331100 | ||||||||
| FaxNumber: | 7249331160 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SEWICKLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151431681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127418700 | ||||||||
| FaxNumber: | 4127413710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2020 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIVENS | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE ADMINISTRATOR II | ||||||||
| AuthorizedOfficialTelephone: | 7249331100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.