MEDICARE: MAST COMMUNITY CHARTER SCHOOL II

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	:	1275985988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAST COMMUNITY CHARTER SCHOOL II

Provider Business Mailing Address
First Line	:	6238 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5621
Country	:	US
Telephone Number	:	267-348-1100
Fax Number	:	267-348-1217

Provider Business Practice Location Address
First Line	:	6238 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5621
Country	:	US
Telephone Number	:	267-348-1100
Fax Number	:	267-348-1217

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN F SWOYER III
Credential	:	CEO
Telephone Number	:	267-348-1100

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	08/16/2016

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