Provider Demographics
NPI:1225512031
Name:PROJECT HOME
Entity Type:Organization
Organization Name:PROJECT HOME
Other - Org Name:PROJECT HOME - PREVENTION POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT HEALTHCARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEDINA MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-320-6187
Mailing Address - Street 1:2144 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4014
Mailing Address - Country:US
Mailing Address - Phone:215-320-5187
Mailing Address - Fax:215-235-4441
Practice Address - Street 1:2913 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3016
Practice Address - Country:US
Practice Address - Phone:215-320-6187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-18
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)