| Covenant House, Inc | |
|
2385 W Cheltenham Ave. Philadelphia PA 19150 | |
| (215) 877-7300 | |
| (215) 844-1020 |
| Full Name | Covenant House, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2385 W Cheltenham Ave., Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Carolyn Richardson (DIRECTOR, REIMBURSEMENT SERVICES) |
| Authorized Official Contact | 2158441020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant House, Inc 2385 W Cheltenham Ave. Philadelphia PA 19150 Ph: (215) 877-7300 | Covenant House, Inc 2385 W Cheltenham Ave. Philadelphia PA 19150 Ph: (215) 877-7300 |
| NPI Number | 1821589615 |
|---|---|
| Provider Enumeration Date | 05/29/2018 |
| Last Update Date | 05/29/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821589615 | NPI | - | NPPES |
| 1007564460003 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 032220 (Pennsylvania) | Primary |
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