Provider Demographics
NPI:1053684662
Name:CHC IMMUNIZATION AND TRAVEL HEALTH CENTER
Entity type:Organization
Organization Name:CHC IMMUNIZATION AND TRAVEL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:PASUMBAL
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-608-7334
Mailing Address - Street 1:5 WINDSOR AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2727
Mailing Address - Country:US
Mailing Address - Phone:610-853-1085
Mailing Address - Fax:610-853-6799
Practice Address - Street 1:5 WINDSOR AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2727
Practice Address - Country:US
Practice Address - Phone:610-853-1085
Practice Address - Fax:610-853-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service