Healthcare Provider Details

I. General information

NPI: 1306896394
Provider Name (Legal Business Name): ESPERANZA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

IV. Provider business mailing address

4417 N. 6TH ST.
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-1100
  • Fax: 215-831-0500
Mailing address:
  • Phone: 215-302-3600
  • Fax: 215-805-8591

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: GLENNA J DEEM
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 215-302-3150