MEDICARE: WEST OAK LANE 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

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	:	1548462146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OAK LANE CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	7115 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1136
Country	:	US
Telephone Number	:	215-927-7995
Fax Number	:	215-927-7980

Provider Business Practice Location Address
First Line	:	7115 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1136
Country	:	US
Telephone Number	:	215-927-7995
Fax Number	:	215-927-7980

Authorized Official
Title or Position	:	CAO
Name	:	MRS. ROBIN A CONBOY
Credential	:
Telephone Number	:	215-927-7995

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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Directions to “WEST OAK LANE CHARTER SCHOOL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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