| Kidspeace Childrens Hospital, Inc. | |
|
1620 Broadway Bethlehem PA 18015-3904 | |
| (610) 799-8600 | |
| (610) 867-9655 |
| Full Name | Kidspeace Childrens Hospital, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1620 Broadway, Bethlehem, Pennsylvania |
| Authorized Official Name and Position | Michael W Slack (COO) |
| Authorized Official Contact | 8008543123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidspeace Childrens Hospital, Inc. 4085 Independence Dr Schnecksville PA 18078 Ph: (800) 854-3123 | Kidspeace Childrens Hospital, Inc. 1620 Broadway Bethlehem PA 18015-3904 Ph: (610) 799-8600 |
| NPI Number | 1326173360 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 03/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326173360 | NPI | - | NPPES |
| 1007283700016 | Medicaid | PA | |
| 1007283700026 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 218750 (Pennsylvania) | Primary |
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