Healthcare Provider Details

I. General information

NPI: 1730396391
Provider Name (Legal Business Name): PHILA. PERFORMING ARTS CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S BROAD ST
PHILADELPHIA PA
19145-4616
US

IV. Provider business mailing address

2600 S BROAD ST
PHILADELPHIA PA
19145-4616
US

V. Phone/Fax

Practice location:
  • Phone: 215-551-4000
  • Fax: 215-551-1113
Mailing address:
  • Phone: 215-551-4000
  • Fax: 215-551-1113

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: GERALD SANTILLI
Title or Position: CONTROLLER
Credential:
Phone: 856-505-1300