Organization
KIDSPEACE CHILDREN'S HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SLACK (CEO)
(610) 799-8405
Entity
Organization
Contact information
Practice address
101 PITTSTON AVE, FIRST FLOOR, SUITE 3, SCRANTON, PA 18505-1150
(570) 342-5444
(570) 342-5539
Mailing address
4085 INDEPENDENCE DRIVE, SCHNECKSVILLE, PA 18078-2574
(610) 799-8525
(610) 799-8318
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
201990
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728370-0043
—
PA
Enumeration date
07/26/2007
Last updated
07/15/2021
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