Provider Demographics
NPI:1558484576
Name:WISSAHICKON CHARTER SCHOOL
Entity type:Organization
Organization Name:WISSAHICKON CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LITTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-338-1020
Mailing Address - Street 1:4700-G WISSAHICKON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:267-338-1020
Mailing Address - Fax:267-338-1030
Practice Address - Street 1:4700-G WISSAHICKON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:267-338-1020
Practice Address - Fax:267-338-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019405740001Medicaid