Organization
COVENANT HOUSE, INC
Active
Organization
COVENANT HOUSE, INC
Active
Other names
Covenant House Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN DENISE STUKES (CHIEF EXECUTIVE OFFICER)
(215) 844-1020
Entity
Organization
Contact information
Practice address
8125 STENTON AVE, PHILADELPHIA, PA 19150-3530
(215) 248-7560
(215) 248-7564
Mailing address
8125 STENTON AVE, PHILADELPHIA, PA 19150-3530
(215) 248-7560
(215) 248-7564
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
032220
PA
Other
Enumeration date
09/30/2009
Last updated
12/20/2023
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