NPIMap

Organization Active NPI

Covenant House Inc

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1699190561
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COVENANT HOUSE INC
Doing business as
Covenant House Health and Dental
Practice address
8127 Stenton Ave
Philadelphia, PA 19150-3530
Phone
(267) 331-9832
Fax
(267) 331-9932
NPI assigned
Feb 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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
Ceo
Phone
(215) 844-1020

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 2

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

Addresses

Primary practice location

8127 Stenton Ave
Philadelphia, PA 19150-3530

Mailing address

8127 Stenton Ave
Philadelphia, PA 19150-3530
Phone (267) 331-9832

Other names 1

  • Covenant House Health and Dental Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200127000062 PA Part A Provider - Federally Qualified Health Center (FQHC) 3476591686 Practice locations: Philadelphia, PA

Federally qualified health center certification: CCN 391153

Legal name
COVENANT HOUSE INC
Doing business as
COVENANT HOUSE HEALTH AND DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 3, 2020
Last certification
Feb 3, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 10, 1966 in PA
Enrollment address
8127 Stenton Ave
Philadelphia, PA 19150-3530

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Covenant House HLTH SVC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8127 Stenton Ave
Philadelphia, PA 19150
Phone (215) 844-1020

138 W Chelten Ave
Philadelphia, PA 19144

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Rosetta L Smith Individual Corporate OfficerChief Executive Officer Nov 18, 1998
W-2 Managing EmployeeChief Executive Officer Dec 5, 2019
Lynn Hargrow Individual Corporate DirectorBoard Member Jun 15, 2025
Wayne Allen Individual Corporate DirectorBoard Member Jun 15, 2025
Gwendolyn Starks Individual Corporate DirectorBoard Member Sep 29, 2010
Carissa Isip Individual Corporate OfficerVice President, Finance Jul 24, 2025
W-2 Managing EmployeeVice President , Finance Jul 24, 2025
Sam Chukwueze Individual Corporate OfficerChief Financial Officer Dec 5, 2012
W-2 Managing EmployeeChief Financial Officer Dec 5, 2019
Bertha R Finney Individual Corporate DirectorBoard Member Sep 26, 2001
Kathleen Card Individual Corporate DirectorBoard Member Feb 8, 2017
Susan D Stukes Individual Corporate OfficerChief Executive Officer Jul 24, 2025
W-2 Managing EmployeeChief Executive Officer Jul 24, 2025
Phyllis L Niblack Individual Corporate DirectorBoard Member Sep 26, 2001
Richard a Kolb Individual Corporate DirectorBoard Member Mar 29, 1975
Charlene Shuler Individual W-2 Managing EmployeeDirector, Revenue Managment Dec 5, 2019
Tracey Wynn Individual Corporate DirectorBoard Member Jun 15, 2025

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1393545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1699190561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8127 STENTON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191503530",
            "telephone_number": "267-331-9832",
            "fax_number": "267-331-9932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8127 STENTON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191503530",
            "telephone_number": "267-331-9832",
            "fax_number": "267-331-9932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-28",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "STUKES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-844-1020",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covenant House Health and Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.