MEDICARE: YOUTH BUILD PHILA CHARTER SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144360660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH BUILD PHILA CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	1231 N BROAD ST
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4021
Country	:	US
Telephone Number	:	215-627-8671
Fax Number	:	215-763-5774

Provider Business Practice Location Address
First Line	:	1231 N BROAD ST
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4021
Country	:	US
Telephone Number	:	215-627-8671
Fax Number	:	215-763-5774

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SIMRAN SIDHU
Credential	:
Telephone Number	:	215-627-8671

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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