Basic Information
| Provider Information | |||||||||
| NPI: | 1306289624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE PHILADELPHIA CHARTER SCHOOL FOR THE ARTS AND SCIENCES AT H.R. EDMU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 LINCOLN DRIVE WEST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565051300 | ||||||||
| FaxNumber: | 8565051300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1197 HAWORTH STREET | ||||||||
| Address2: | |||||||||
| City: | PHIADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155372520 | ||||||||
| FaxNumber: | 2155372861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | FEOLA | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRINCIPAL | ||||||||
| AuthorizedOfficialTelephone: | 2155372520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | School |
No ID Information.