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Divine Providence Village

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Philadelphia, PA

NPI 1063530756 · NPPES record last updated Mar 28, 2024

Key facts

NPI
1063530756
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
1804 Dallas St
Philadelphia, PA 19126-1519
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) 19

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Divine Providence Village (124 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X PA Yes

Addresses

Primary practice location

1804 Dallas St
Philadelphia, PA 19126-1519

Mailing address

686 Old Marple Rd
Springfield, PA 19064-1239
Phone (610) 328-7730

Other identifiers

IdentifierTypeStateIssuer
1000031590092MedicaidPA

Other providers in Philadelphia, PA

All providers in Philadelphia, PA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pennsylvania

Sources for this page

Verify at the official NPI Registry.