| Covenant House Inc. | |
|
251 E Bringhurst St Philadelphia PA 19144-1719 | |
| (215) 844-1020 | |
| (215) 844-2702 |
| Full Name | Covenant House Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 251 E Bringhurst St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Susan Denise Stukes (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2158441020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant House Inc. 251 E Bringhurst St Philadelphia PA 19144-1719 Ph: (215) 844-1020 | Covenant House Inc. 251 E Bringhurst St Philadelphia PA 19144-1719 Ph: (215) 844-1020 |
| NPI Number | 1720361447 |
|---|---|
| Provider Enumeration Date | 09/20/2011 |
| Last Update Date | 09/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720361447 | NPI | - | NPPES |
| 00652 | Other | PA | HEALTH PARTNERS |
| 1007564460003 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 032220 (Pennsylvania) | Primary |
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