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Divine Providence Village

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

NPI 1801915418 · NPPES record last updated Nov 17, 2015

Key facts

NPI
1801915418
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
106 Woodlyn Ave
Unit #4
Glenside, PA 19038-4743
Phone
(610) 543-5410
Fax
(610) 543-5397
NPI assigned
Mar 28, 2007
Organization subpart
No

Authorized official

Name
Mr. Fran Swiacki
Title
Divisional Director
Phone
(610) 543-3380

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

106 Woodlyn Ave
Unit #4
Glenside, PA 19038-4743

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1000031590087MedicaidPA

Other providers in Glenside, PA

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

Sources for this page

Verify at the official NPI Registry.