Provider Demographics
NPI:1699868398
Name:CHILDREN'S HOSPITAL AT MISSION
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL AT MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPPERT SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-509-8451
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-997-3000
Mailing Address - Fax:714-532-8753
Practice Address - Street 1:27700 MEDICAL CENTER RD FL 5
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:714-997-3000
Practice Address - Fax:714-532-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACHMOtherUNIVERSAL CARE
CA5666OtherBLUE CROSS
CA0002OtherCHAMPUS
CAHSP43306FMedicaid
CAHSP33306FMedicaid
CAZZZD3001ZOtherBLUE SHIELD
CA053306Medicare ID - Type Unspecified