Healthcare Provider Details

I. General information

NPI: 1255726659
Provider Name (Legal Business Name): ESPERANZA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 N 6TH ST ESPERANZA HEALTH CEN
PHILADELPHIA PA
19140-2319
US

IV. Provider business mailing address

4417 N 6TH ST ESPERANZA HEALTH CEN
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-3150
  • Fax:
Mailing address:
  • Phone: 215-302-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN M POST
Title or Position: EXECUTIVE DIRECTOR
Credential: D.MIN, MBA
Phone: 215-302-3150