MEDICARE: IMANI EDUCATION CIRCLE 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)

General Provider Information

NPI Number	:	1497943799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMANI EDUCATION CIRCLE CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	5612 GREENE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2808
Country	:	US
Telephone Number	:	215-713-9240
Fax Number	:	215-713-9286

Provider Business Practice Location Address
First Line	:	5612 GREENE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2808
Country	:	US
Telephone Number	:	215-713-9240
Fax Number	:	215-713-9286

Authorized Official
Title or Position	:	CEO
Name	:	DR. FRANCINE FULOTON
Credential	:	PH.D
Telephone Number	:	215-713-9240

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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