Provider Demographics
NPI:1700925369
Name:PHILADELPHIA ACADEMY CHARTER SCHOOL
Entity Type:Organization
Organization Name:PHILADELPHIA ACADEMY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-676-8320
Mailing Address - Street 1:11000 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3961
Mailing Address - Country:US
Mailing Address - Phone:215-676-8320
Mailing Address - Fax:215-676-8340
Practice Address - Street 1:11000 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3961
Practice Address - Country:US
Practice Address - Phone:215-676-8320
Practice Address - Fax:215-676-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017732510001Medicaid