MEDICARE: GLOBAL LEADERSHIP ACADEMY CHARTER SCHOOL SOUTHWEST AT HUEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1144771486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL LEADERSHIP ACADEMY CHARTER SCHOOL SOUTHWEST AT HUEY

Provider Business Mailing Address
First Line	:	5200 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1521
Country	:	US
Telephone Number	:	215-471-2978
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1521
Country	:	US
Telephone Number	:	215-471-2978
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TAMIKA EVANS
Credential	:
Telephone Number	:	215-471-2978

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	10/21/2016

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