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NPI Code Detail

MEDICARE: PROJECT HOME

MEDICARE: PROJECT HOME
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1609122506
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROJECT HOME
Provider Business Mailing Address
First Line : 2144 CECIL B MOORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19121-4014
Country : US
Telephone Number : 215-320-6192
Fax Number : 484-229-3346
Provider Business Practice Location Address
First Line : 2144 CECIL B MOORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19121-4014
Country : US
Telephone Number : 215-320-6187
Fax Number : 215-235-4441
Authorized Official
Title or Position : BILLING SUPERVISOR
Name : ANITA RICHARDSON
Credential :
Telephone Number : 215-320-6192
Provider Enumeration Date : 07/28/2012
Last Update Date : 05/29/2024

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Directions to “PROJECT HOME ” Practice Location

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