Provider Demographics
NPI:1497912794
Name:WEST PHILADELPHIA ACHIEVEMENT CHARTER SCHOOL
Entity Type:Organization
Organization Name:WEST PHILADELPHIA ACHIEVEMENT CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-476-6471
Mailing Address - Street 1:6701 CALLOWHILL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3603
Mailing Address - Country:US
Mailing Address - Phone:215-476-6471
Mailing Address - Fax:215-476-0431
Practice Address - Street 1:6701 CALLOWHILL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3603
Practice Address - Country:US
Practice Address - Phone:215-476-6471
Practice Address - Fax:215-476-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012880260001Medicaid