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Organization

COVENANT HOUSE INC

Active
Parent organization
COVENANT HOUSE INC
Other names
Tabor Kids Pediatric Mini Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
COVENANT HOUSE INC
Authorized official
DR. SUSAN DENISE STUKES (CHIEF EXECUTIVE OFFICER)
(215) 844-1020
Entity
Organization

Contact information

Practice address
57 E ARMAT ST, PHILADELPHIA, PA 19144-2201
(215) 844-1020
(215) 844-2702
Mailing address
251 E BRINGHURST ST, PHILADELPHIA, PA 19144-1719
(215) 844-1020
(215) 844-2702

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Enumeration date
04/04/2023
Last updated
09/20/2023
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