Provider Demographics
NPI:1790116788
Name:PROJECT HOME
Entity Type:Organization
Organization Name:PROJECT HOME
Other - Org Name:PATHWAYS TO HOUSING FQHC SITE
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL PROJECTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-320-6187
Mailing Address - Street 1:1415 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2907
Mailing Address - Country:US
Mailing Address - Phone:215-232-7229
Mailing Address - Fax:
Practice Address - Street 1:5201 OLD YORK RD STE 108
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2987
Practice Address - Country:US
Practice Address - Phone:215-390-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
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)