Healthcare Provider Details

I. General information

NPI: 1083663017
Provider Name (Legal Business Name): BELMONT ACADEMY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 LOCUST ST
PHILADELPHIA PA
19103-6305
US

IV. Provider business mailing address

1630 LOCUST ST
PHILADELPHIA PA
19103-6305
US

V. Phone/Fax

Practice location:
  • Phone: 215-790-1294
  • Fax: 215-790-1475
Mailing address:
  • Phone: 215-790-1294
  • Fax: 215-790-1475

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: ALICE C LUNSFORD
Title or Position: CEO
Credential:
Phone: 215-790-1294