Organization
DIVINE PROVIDENCE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN ENGEL (HIPAA OFFICER)
(610) 525-8800
Entity
Organization
Contact information
Practice address
99 S SPROUL RD, BROOMALL, PA 19008-2334
(610) 543-5410
(610) 543-5397
Mailing address
686 OLD MARPLE RD, SPRINGFIELD, PA 19064-1239
(610) 328-7730
(610) 544-1710
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000031590103
—
PA
Enumeration date
03/27/2007
Last updated
04/05/2024
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