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DIVINE PROVIDENCE VILLAGE NPI 1811015985


NPI Information

NPI: 1811015985
Provider Name: DIVINE PROVIDENCE VILLAGE
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
4545 OAKMONT ST
PHILADELPHIA, PA
ZIP 19136
Phone: (610) 543-5410
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DIVINE PROVIDENCE VILLAGE is a community based residential treatment facility, intellectual and/or developmental disabilities in Philadelphia, PA. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. DIVINE PROVIDENCE VILLAGE NPI is 1811015985. The provider is registered as an organization entity type.

The provider's business location address is:

4545 OAKMONT ST
PHILADELPHIA, PA
ZIP 19136-703
Phone: (610) 543-5410
Fax: (610) 543-5397

The provider's authorized official is Fran Swiacki .
The authorized official title is Divisional Director and has the following contact phone number (610) 543-3380.

The enumeration date for this NPI number is 3/27/2007 and was last updated on 11/16/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11000031590107MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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