MEDICARE: EUGENIO MARIA DEHOSTOS CHARTER SCHOOL

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)		PA

General Provider Information

NPI Number	:	1215164710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENIO MARIA DEHOSTOS CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	2726 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2714
Country	:	US
Telephone Number	:	215-229-1226
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2714
Country	:	US
Telephone Number	:	215-229-1226
Fax Number	:

Authorized Official
Title or Position	:	CAO/SCHOOL DIRECTOR
Name	:	DIANA M GARCIA
Credential	:
Telephone Number	:	215-455-2300

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	06/11/2009

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