Organization
COVENANT HOUSE, INC
Active
Other names
Covenant House Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN RICHARDSON (DIRECTOR, REIMBURSEMENT SERVICES)
(215) 844-1020
Entity
Organization
Contact information
Practice address
2385 W CHELTENHAM AVE., PHILADELPHIA, PA 19150
(215) 877-7300
(215) 844-1020
Mailing address
2385 W CHELTENHAM AVE., PHILADELPHIA, PA 19150
(215) 877-7300
(215) 844-1020
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
032220
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007564460003
—
PA
Enumeration date
05/29/2018
Last updated
05/29/2018
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