Healthcare Provider Details

I. General information

NPI: 1821761990
Provider Name (Legal Business Name): CHPH TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E GIRARD AVE APT 1
PHILADELPHIA PA
19125-3400
US

IV. Provider business mailing address

625 E GIRARD AVE APT 1
PHILADELPHIA PA
19125-3400
US

V. Phone/Fax

Practice location:
  • Phone: 267-439-0966
  • Fax: 215-425-4400
Mailing address:
  • Phone: 267-439-0966
  • Fax: 215-425-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. IKISHIA NATAYE JACKSON
Title or Position: ADMINISTRATOR/ OWNER
Credential: REGISTERED NURSE
Phone: 267-439-0966