NPIMap

Organization Active NPI

Divine Providence Village

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Feasterville Trevose, PA
National Provider Identifier
1215055363
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
DIVINE PROVIDENCE VILLAGE
Practice address
1510 Pleasant Dr
Feasterville Trevose, PA 19053-4434
Phone
(610) 543-5410
Fax
(610) 543-5397
NPI assigned
Mar 27, 2007
Last updated
Mar 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn Engel
Title
Hipaa Officer
Phone
(610) 525-8800

Specialties & licenses 1

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

Addresses

Primary practice location

1510 Pleasant Dr
Feasterville Trevose, PA 19053-4434

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1000031590088MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Divine Providence Village124 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1215055363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 OLD MARPLE RD",
            "city": "SPRINGFIELD",
            "state": "PA",
            "postal_code": "190641239",
            "telephone_number": "610-328-7730",
            "fax_number": "610-544-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 PLEASANT DR",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190534434",
            "telephone_number": "610-543-5410",
            "fax_number": "610-543-5397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "ENGEL",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "HIPAA OFFICER",
        "authorized_official_telephone_number": "610-525-8800"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000031590088",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Feasterville Trevose, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.