Healthcare Provider Details

I. General information

NPI: 1598919300
Provider Name (Legal Business Name): PAN AMERICAN ACADEMY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WEST DAUPHIN STREET
PHILADELPHIA PA
19133
US

IV. Provider business mailing address

126 WEST DAUPHIN STREET
PHILADELPHIA PA
19133
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-1212
  • Fax: 215-423-0871
Mailing address:
  • Phone: 215-425-1212
  • Fax: 215-423-0871

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. ELIZABETH J RICHARDS
Title or Position: SPECIAL EDUCATION ADMINISTRATOR
Credential:
Phone: 215-425-1212