Provider Demographics
NPI:1629202742
Name:PHILADELPHIA HEALTH & EDUCATION CORPORATION
Entity Type:Organization
Organization Name:PHILADELPHIA HEALTH & EDUCATION CORPORATION
Other - Org Name:DUCOM FAMILY PLANNING COUNCIL PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC DEAN OF OPERATIONS &CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-255-7755
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:
Practice Address - Street 1:1427 VINE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1031
Practice Address - Country:US
Practice Address - Phone:215-762-2533
Practice Address - Fax:215-762-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007571110396Medicaid