NPIMap

Organization Active NPI

Covenant House, Inc

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1821589615
Registry record updated May 29, 2018
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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
Doing business as
Covenant House Wellness Clinic
Practice address
2385 W Cheltenham Ave.
Philadelphia, PA 19150
Phone
(215) 877-7300
Fax
(215) 844-1020
NPI assigned
May 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Authorized official

Name
Carolyn Richardson
Title
Director, Reimbursement Services
Phone
(215) 844-1020

Specialties & licenses 1

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

Addresses

Primary practice location

2385 W Cheltenham Ave.
Philadelphia, PA 19150

Mailing address

2385 W Cheltenham Ave.
Philadelphia, PA 19150
Phone (215) 877-7300

Other identifiers 1

IdentifierTypeStateIssuer
1007564460003MedicaidPA

Other names 1

  • Covenant House Wellness Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 391117

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COVENANT HOUSE INCORPORATED WELLNESS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2018
Last certification
Aug 8, 2018
Ownership / control type
For profit – corporation
Facility address
2385 W Cheltenham Avenue
Philadelphia, PA 19150

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1821589615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2385 W CHELTENHAM AVE.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19150",
            "telephone_number": "215-877-7300",
            "fax_number": "215-844-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2385 W CHELTENHAM AVE.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19150",
            "telephone_number": "215-877-7300",
            "fax_number": "215-844-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "DIRECTOR, REIMBURSEMENT SERVICES",
        "authorized_official_telephone_number": "215-844-1020"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": "032220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007564460003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covenant House Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Covenant House Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.