COVENANT HOUSE INC. NPI 1720361447

NPI Information

COVENANT HOUSE INC. is a federally qualified health center (fqhc) clinic center in Philadelphia, PA. COVENANT HOUSE INC. NPI is 1720361447. The provider is registered as an organization entity type.

The provider's business location address is:

251 E BRINGHURST ST
PHILADELPHIA, PA
ZIP 19144-719
Phone: (215) 844-1020
Fax: (215) 844-2702

The provider's authorized official is Rosetta L Smith .
The authorized official title is Chief Executive Officer and has the following contact phone number (215) 844-1020.

The CLIA number assigned to this NPI record is 39D0201579 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/20/2011 and was last updated on 9/20/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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