Organization
COVENANT HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN DENISE STUKES (CHIEF EXECUTIVE OFFICER)
(561) 672-4789
Entity
Organization
Contact information
Practice address
251 EAST BRINGHURST STREET, PHILADELPHIA, PA 19144
(215) 844-1020
(215) 844-2702
Mailing address
251 EAST BRINGHURST STREET, PHILADELPHIA, PA 19144
(215) 844-1020
(215) 844-2702
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
032220
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00652
HEALTH PARTNERS
—
01
—
0073796701
AMERI CHOICE
—
05
—
1007564460003
—
PA
01
—
1026476
KEYSTONE MERCY HEALTH PLA
—
Enumeration date
09/27/2006
Last updated
08/22/2025
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