=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730396391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILA. PERFORMING ARTS CHARTER SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 S BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-551-4000
-----------------------------------------------------
Fax | 215-551-1113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 S BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-551-4000
-----------------------------------------------------
Fax | 215-551-1113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | GERALD SANTILLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-505-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------