COVENANT HOUSE, INC (NPI# 1821589615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821589615 |
| Entity Type | Organization |
| Organization Name | COVENANT HOUSE, INC |
| Other Organization Name | COVENANT HOUSE WELLNESS CLINIC |
| Practice Address |
2385 W Cheltenham Ave. Philadelphia PA 19150 |
| Practice Telephone | 2158777300 |
| Practice Fax Number | 2158441020 |
| Mailing Telephone | 2158777300 |
| Mailing Fax Number | 2158441020 |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |
| Authorized Official Name | CAROLYN RICHARDSON (DIRECTOR, REIMBURSEMENT SERVICES) |
| Authorized Official Telephone | 2158441020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
032220 | PA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1007564460003 | 05 |
| Other Name | Type Code |
|---|---|
| Covenant House Wellness Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528392008 | Covenant House, Inc | Clinic/Center | 8125 Stenton Ave, Philadelphia, PA 19150-3530 | 2009-09-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COVENANT HOUSE, INC. | 600 Shrewsbury St Ste 1, Charleston, WV 25301-1230 |
| Street Address |
2385 W CHELTENHAM AVE. |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326553074 | Prime Health Pharmacy LLC | Pharmacy | 1514 Wadsworth Ave, Philadelphia, PA 19150 | 2017-12-04 |
| 1609319797 | Ivy Hill Rehab Center LLC | Skilled Nursing Facility | 140 Ivy Hill Road, Wyndmoor, PA 19150 | 2016-11-22 |
| 1831563857 | Kutest Kids | Early Intervention Provider Agency | 7811 Cedarbrook Avenue, Philadelphia, PA 19150 | 2015-11-16 |
| 1487044020 | Stefanie Black | Pharmacy Technician | 2527 Target Pharmacy, Philadelphia, PA 19150 | 2015-02-04 |
| 1003206590 | Fatima Jackson | Pharmacy Technician | 2527 Shoppers Lane, Cheltenham Square Mall, Philadelphia, PA 19150 | 2015-02-04 |
| 1215351762 | Hilltop Medical Associates, PC | General Practice | 2350 W. Cheltenham Ave, Philadelphia, PA 19150 | 2014-02-04 |
| 1801219472 | Fatima Bangura | Registered Nurse | Excel Medical Center, LLC, 7515 Stenton Avenue, Philadelphia, PA 19150 | 2014-02-01 |
| 1386082089 | Enjalee Jennifer Thomas-finnagan | Behavioral Analyst | 8324 Temple Rd, Phila, PA 19150 | 2013-06-05 |
| 1235572538 | Blessy Mathew | Nurse Practitioner | 2385 Cheltenham Avenue, Philadelphia, PA 19150 | 2013-04-17 |
| 1942544697 | Walter L. Patterson Jr. | General Practice | 1501 E. Wadsworth Ave., Philadelphia, PA 19150 | 2012-11-19 |
| Find all providers in zip 19150 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1679133268 | Public Health Management Corporation | Clinic/Center | 315 S Broad St, Philadelphia, PA 19107-5213 | 2019-06-17 |
| 1225536568 | Delaware Valley Community Health, Inc. | Clinic/Center | 400 W Allegheny Ave Bldg 5b, Philadelphia, PA 19133-3639 | 2018-01-31 |
| 1073037826 | Greater Philadelphia Health Action Inc. | Clinic/Center | 5630 Vine Street, Philadelphia, PA 19139-4703 | 2017-08-02 |
| 1225552177 | Greater Philadelphia Health Action Inc. | Clinic/Center | 3301 Tasker Street, Philadelphia, PA 19145-9996 | 2017-08-02 |
| 1235653080 | Greater Philadelphia Health Action Inc. | Clinic/Center | 3200 Dickinson Street, Philadelphia, PA 19146-9733 | 2017-08-02 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19150 |
Please comment or provide details below to improve the information on COVENANT HOUSE, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.