Healthcare Provider Details

I. General information

NPI: 1033168026
Provider Name (Legal Business Name): INDEPENDENCE CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 7TH ST
PHILADELPHIA PA
19106-3324
US

IV. Provider business mailing address

105 S 7TH ST
PHILADELPHIA PA
19106-3324
US

V. Phone/Fax

Practice location:
  • Phone: 215-238-8000
  • Fax: 215-238-1998
Mailing address:
  • Phone: 215-238-8000
  • Fax: 215-238-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StatePA

VIII. Authorized Official

Name: MS. JURATE KROKYS
Title or Position: PRINCIPAL/CEO
Credential: M.ED.
Phone: 215-238-8000