Organization
DIVINE PROVIDENCE VILLAGE
Active
Other names
DPV Respite
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK E FITZGERALD NHA, MSW (DIRECTOR, MR SERVICES)
(610) 543-6602
Entity
Organization
Contact information
Practice address
686 OLD MARPLE RD, SPRINGFIELD, PA 19064-1239
(610) 328-7730
(610) 544-1710
Mailing address
686 OLD MARPLE RD, SPRINGFIELD, PA 19064-1239
(610) 328-7730
(610) 544-1710
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000031590003
—
PA
Enumeration date
03/23/2007
Last updated
08/22/2020
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