Provider Demographics
NPI:1326469735
Name:BRAVO HEALTH PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:BRAVO HEALTH PENNSYLVANIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:571-401-5886
Mailing Address - Street 1:1500 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4067
Mailing Address - Country:US
Mailing Address - Phone:832-553-3375
Mailing Address - Fax:
Practice Address - Street 1:1500 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4067
Practice Address - Country:US
Practice Address - Phone:832-553-3375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIGNA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11524302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization