# DIVINE PROVIDENCE VILLAGE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DPV Respite
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669599874
- **Authorized official:** MR. MARK E FITZGERALD NHA, MSW (DIRECTOR, MR SERVICES)
- **Authorized official phone:** (610) 543-6602

## Contact information

- **Practice address:** 686 OLD MARPLE RD, SPRINGFIELD, PA 19064-1239
- **Practice address phone:** (610) 328-7730
- **Practice address fax:** (610) 544-1710
- **Mailing address:** 686 OLD MARPLE RD, SPRINGFIELD, PA 19064-1239
- **Mailing address phone:** (610) 328-7730
- **Mailing address fax:** (610) 544-1710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | PA | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1000031590003 | — | PA |