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Divine Providence Village

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

NPI 1255459657 · NPPES record last updated Apr 2, 2024

Key facts

NPI
1255459657
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
3 Herford PL
Lansdowne, PA 19050-2408
Phone
(610) 543-5410
Fax
(610) 543-5397
NPI assigned
Mar 26, 2007
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

3 Herford PL
Lansdowne, PA 19050-2408

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1000031590066MedicaidPA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 2, 2024.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1255459657",
    "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": "3 HERFORD PL",
            "city": "LANSDOWNE",
            "state": "PA",
            "postal_code": "190502408",
            "telephone_number": "610-543-5410",
            "fax_number": "610-543-5397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "ENGEL",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "HIPAA OFFER",
        "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": "1000031590066",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansdowne, PA

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Sources for this page

Verify at the official NPI Registry.