Healthcare Provider Details

I. General information

NPI: 1194065755
Provider Name (Legal Business Name): OLNEY CHARTER HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W DUNCANNON AVE
PHILADELPHIA PA
19120-3410
US

IV. Provider business mailing address

100 W DUNCANNON AVE
PHILADELPHIA PA
19120-3410
US

V. Phone/Fax

Practice location:
  • Phone: 215-375-5110
  • Fax:
Mailing address:
  • Phone: 215-375-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number126513452
License Number State

VIII. Authorized Official

Name: MARYELLEN HANNIGAN
Title or Position: SPED. ADMINISTRATIVE ASSISTANT
Credential:
Phone: 215-375-5110