NPIMap

Organization Active NPI

Divine Providence Village

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Upper Darby, PA
National Provider Identifier
1497874093
Registry record updated Apr 2, 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
156 Copley Rd
Upper Darby, PA 19082-3103
Phone
(610) 543-5410
Fax
(610) 543-5397
NPI assigned
Mar 28, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dawn Engel
Title
Hipaa Officer
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

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

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

156 Copley Rd
Upper Darby, PA 19082-3103

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1000031590116MedicaidPA

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1497874093",
    "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": "156 COPLEY RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190823103",
            "telephone_number": "610-543-5410",
            "fax_number": "610-543-5397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "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 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": "1000031590116",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Darby, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.