MEDICARE: ESPERANZA HEALTH CENTER, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306933346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESPERANZA HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	4417 N. 6TH ST.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2319
Country	:	US
Telephone Number	:	215-302-3600
Fax Number	:	215-805-8591

Provider Business Practice Location Address
First Line	:	2940 N. 5TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	215-221-6633
Fax Number	:	215-224-5644

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. SUSAN M POST
Credential	:	D.MIN., MBA
Telephone Number	:	215-302-3600

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/17/2012

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