Provider Demographics
NPI:1063122745
Name:CHILDREN'S HEALTH COUCIL
Entity type:Organization
Organization Name:CHILDREN'S HEALTH COUCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE & HIM
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-688-3612
Mailing Address - Street 1:650 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2300
Mailing Address - Country:US
Mailing Address - Phone:650-326-5530
Mailing Address - Fax:650-688-3669
Practice Address - Street 1:1765 E BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2503
Practice Address - Country:US
Practice Address - Phone:650-326-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health