MEDICARE: JOHN B. STETSON 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)

General Provider Information

NPI Number	:	1285079285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN B. STETSON CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	3200 B ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2202
Country	:	US
Telephone Number	:	215-291-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 B ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2202
Country	:	US
Telephone Number	:	215-291-4720
Fax Number	:

Authorized Official
Title or Position	:	LEAD ADMIN ASSISTANT
Name	:	MRS. SULAIH PICORELLI
Credential	:
Telephone Number	:	215-329-2733

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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