Organization
LOS NINOS HOSPITAL INC.
Active
Organization
LOS NINOS HOSPITAL INC.
Active
Other names
Los Ninos Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
DALE NORMAN SKURDAHL (CHIEF OPERATING OFFICER-M.S.)
(602) 243-4231
Entity
Organization
Contact information
Practice address
2303 E. THOMAS RD, PHOENIX, AZ 85016
(902) 954-7311
(902) 954-7355
Mailing address
1402 E. SOUTH MOUNTAIN AVENUE, PHOENIX, AZ 85042
(602) 243-4231
(602) 323-5988
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
SHO188
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D0898997
CLIA WAIVER
AZ
05
—
155128
—
AZ
01
—
SHO188
STATE LICENSE
AZ
Enumeration date
10/07/2006
Last updated
08/22/2020
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