Organization Name: | DIVINE PROVIDENCE VILLAGE |
NPI Number: | 1023136181 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRAN SWIACKI (DIVISIONAL DIRECTOR) |
Mailing Address: | 1825 N 59th St Philadelphia |
State: | PA US |
Postal Code: | 191513512 |
Phone Number: | 6105435410 |
Fax Number: | 6105435397 |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 11/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |