Organization
COVENANT HOUSE INC.
Active
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
251 E BRINGHURST ST, PHILADELPHIA, PA 19144-1719
(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
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
032220
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00652
HEALTH PARTNERS
PA
05
—
1007564460003
—
PA
Enumeration date
09/20/2011
Last updated
09/20/2023
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