=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447307517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHOOL DISTRICT OF PHILADELPHIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 01/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 N BROAD ST 3RD FLOOR - SUITE 323
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-400-4580
-----------------------------------------------------
Fax | 215-400-4582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 N BROAD ST 3RD FLOOR - SUITE 323
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-400-4580
-----------------------------------------------------
Fax | 215-400-4582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIN SVCS DIR, ACCESS PROGRAM
-----------------------------------------------------
Name | MICHELLE OVINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-400-5476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------