Divine Providence Village
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Philadelphia, PA
NPI 1023136181 · NPPES record last updated Mar 28, 2024
Key facts
- NPI
- 1023136181
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- DIVINE PROVIDENCE VILLAGE
- Practice address
- 902 69TH Ave
Philadelphia, PA 19126-2909 - Phone
- (610) 543-5410
- Fax
- (610) 543-5397
- NPI assigned
- Mar 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Dawn Engel
- Title
- Hipaa Officer
- Phone
- (610) 525-8800
Corporate family (same tax ID) 17
National Provider Directory
- Tax ID family
- Divine Providence Village
Locations
1825 N 59th St
Philadelphia, PA 19151
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | PA | Yes |
Addresses
Primary practice location
902 69TH Ave
Philadelphia, PA 19126-2909
Mailing address
686 Old Marple Rd
Springfield, PA 19064-1239
Phone (610) 328-7730
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000031590122 | Medicaid | PA |
Other providers in Philadelphia, PA
- Divine Nursing Care LLC
- Divine Path Home Care LLC
- Divine Providence Healthcare, LLC
- Divine Providence Healthcare, LLC
- Divine Providence Village
- Divine Providence Village
- Divine Providence Village
- Divine Providence Village
- Divine Providence Village
- Divine Providence Village
All providers in Philadelphia, PA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.