NPIMap

Organization Active NPI

Covenant House Inc

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1659462679
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
032220 Issued in PA
Legal business name
COVENANT HOUSE INC
Practice address
251 East Bringhurst Street
Philadelphia, PA 19144
Phone
(215) 844-1020
Fax
(215) 844-2702
NPI assigned
Sep 27, 2006
Last updated
Aug 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Susan Denise StukesNPI 1306146923
Title
Chief Executive Officer
Phone
(561) 672-4789

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 032220 PA Primary

Addresses

Primary practice location

251 East Bringhurst Street
Philadelphia, PA 19144

Mailing address

251 East Bringhurst Street
Philadelphia, PA 19144
Phone (215) 844-1020

Other identifiers 4

IdentifierTypeStateIssuer
0073796701OtherAMERI CHOICE
00652OtherHEALTH PARTNERS
1026476OtherKEYSTONE MERCY HEALTH PLA
1007564460003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050419000796 PA Part B Supplier - Clinic/Group Practice 3476591686 Receives reassigned benefits from 16 practitioners
Practice locations: Philadelphia, PA
O20111107000566 PA Part A Provider - Federally Qualified Health Center (FQHC) 3476591686 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20161130000041 PA Part A Provider - Federally Qualified Health Center (FQHC) 3476591686 Practice locations: Philadelphia, PA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1659462679. Details of each certification follow.

Federally qualified health center certification: CCN 391018

Legal name
COVENANT HOUSE INC
Doing business as
COVENANT HOUSE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2011
Last certification
Nov 15, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 10, 1966 in PA
Enrollment address
8125 Stenton Ave
Philadelphia, PA 19150-3530

Federally qualified health center certification: CCN 391091

Legal name
COVENANT HOUSE INC
Doing business as
CONVENANT HOUSE HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2016
Last certification
Nov 30, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 10, 1966 in PA
Enrollment address
251 E Bringhurst St
Philadelphia, PA 19144-1799

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Francine Fulton Individual Corporate Director Dec 10, 2021
Other Dec 10, 2021
Gwendolyn Starks Individual Corporate DirectorBoard Member Sep 29, 2010
Other May 29, 2018
Sam Chukwueze Individual Corporate OfficerCfo Dec 5, 2012
W-2 Managing EmployeeChief Financial Officer Sep 1, 2016
Corporate OfficerChief Financial Officer Dec 5, 2012 25%
W-2 Managing Employee Dec 5, 2012
Bertha R Finney Individual Corporate DirectorBoard Member Sep 26, 2001
Kathleen Card Individual Corporate DirectorBoard Member Feb 8, 2017
Other Feb 8, 2017
Susan D Stukes Individual Corporate OfficerCeo Jul 1, 2023
W-2 Managing Employee Jul 1, 2023
Corporate OfficerCeo Jul 1, 2023 75%
W-2 Managing EmployeeCeo Jul 1, 2023
Phyllis L Niblack Individual Corporate DirectorBoard Member Sep 26, 2001
Other May 29, 2018
Richard a Kolb Individual Corporate DirectorBoard Member Mar 29, 1995
Carolyn Richardson Individual Corporate Director Jan 12, 2009
W-2 Managing EmployeeDirector Reimbursement Sevices Jan 12, 2009
W-2 Managing Employee Jan 26, 2009
Cory Clark Individual Corporate DirectorBoard Member Apr 25, 2018
Other Apr 25, 2018
Charlene Shuler Individual W-2 Managing EmployeeDirector Revenue Management Apr 6, 2022
Corporate Director May 15, 2017
W-2 Managing Employee May 15, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1659462679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 EAST BRINGHURST STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19144",
            "telephone_number": "215-844-1020",
            "fax_number": "215-844-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 EAST BRINGHURST STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19144",
            "telephone_number": "215-844-1020",
            "fax_number": "215-844-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "STUKES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "561-672-4789",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": "032220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERI CHOICE",
            "identifier": "0073796701",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "00652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTH PLA",
            "identifier": "1026476",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007564460003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.