Provider Demographics
NPI:1326427022
Name:HEALTH PROMOTION COUNCIL OF SOUTHEASTERN PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:HEALTH PROMOTION COUNCIL OF SOUTHEASTERN PENNSYLVANIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF QUALITY & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-765-2334
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:CENTRE SQUARE EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:215-731-6189
Mailing Address - Fax:215-731-6199
Practice Address - Street 1:1500 MARKET ST
Practice Address - Street 2:CENTRE SQUARE EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2100
Practice Address - Country:US
Practice Address - Phone:215-731-6189
Practice Address - Fax:215-731-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty