| Kidspeace Children's Hospital, Inc. | |
|
1151 Pocono Blvd Ste 2 Mount Pocono PA 18344-1033 | |
| (570) 243-8787 | |
| (570) 243-8797 |
| Full Name | Kidspeace Children's Hospital, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1151 Pocono Blvd Ste 2, Mount Pocono, Pennsylvania |
| Authorized Official Name and Position | Michael W. Slack (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 6107998405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidspeace Children's Hospital, Inc. 4085 Independence Dr Schnecksville PA 18078-2574 Ph: (800) 854-3123 | Kidspeace Children's Hospital, Inc. 1151 Pocono Blvd Ste 2 Mount Pocono PA 18344-1033 Ph: (570) 243-8787 |
| NPI Number | 1598932261 |
|---|---|
| Provider Enumeration Date | 05/13/2008 |
| Last Update Date | 03/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598932261 | NPI | - | NPPES |
| 100728370-0016 | Medicaid | PA | |
| 1007283700028 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 218750 (Pennsylvania) | Primary |
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