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General NPI Number Information
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NPI Number | 1699190561
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Entity Type | Organization
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Legal Business Name | COVENANT HOUSE INC
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 8127 STENTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-3530
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Country | US
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Telephone | 267-331-9832
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Fax | 267-331-9932
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Provider Business Mailing Address
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Address Line | 8127 STENTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-3530
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Country | US
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Telephone | 267-331-9832
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Fax | 267-331-9932
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Authorized Official
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Title or Position | CEO
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Name | DR. SUSAN DENISE STUKES
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Credential |
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Telephone | 215-844-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | PA
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