Provider Demographics
NPI:1225270499
Name:CHESPENN HEALTH SERVICES
Entity Type:Organization
Organization Name:CHESPENN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-485-3800
Mailing Address - Street 1:2600 W 9TH ST
Mailing Address - Street 2:2 NORTH
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-2040
Mailing Address - Country:US
Mailing Address - Phone:610-485-3800
Mailing Address - Fax:610-485-4221
Practice Address - Street 1:2602 W 9TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2040
Practice Address - Country:US
Practice Address - Phone:610-497-2900
Practice Address - Fax:610-497-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100728281-006Medicaid