Organization
KIDSPEACE CHILDREN'S HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CALLAN (CFO)
(610) 799-7517
Entity
Organization
Contact information
Practice address
100 4TH ST STE 5, HONESDALE, PA 18431-1869
(570) 253-7910
(570) 253-7985
Mailing address
4085 INDEPENDENCE DR, SCHNECKSVILLE, PA 18078-2574
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728370-0043
—
PA
Enumeration date
12/15/2020
Last updated
12/15/2020
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