Organization
PHOENIX CHILDREN'S HOSPITAL
Active
Parent organization
PHOENIX CHILDREN'S HOSPITAL
Other names
Phoenix Children's Hospital - Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHOENIX CHILDREN'S HOSPITAL
Authorized official
RAHEEL FAROUGH (SVP, MANAGED CARE & PAYOR STRATEGY)
(602) 933-3548
Entity
Organization
Contact information
Practice address
1920 E CAMBRIDGE AVE, STE 102, PHOENIX, AZ 85006-1459
(602) 933-3220
(602) 933-0502
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
MED2169
AZ
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
OTC 3741
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MED2169
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
01/16/2007
Last updated
05/22/2023
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