Provider Demographics
NPI:1003949157
Name:COMMUNITIES OF DON GUANELLA AND DIVINE PROVIDENCE
Entity Type:Organization
Organization Name:COMMUNITIES OF DON GUANELLA AND DIVINE PROVIDENCE
Other - Org Name:DON GUANELLA VILLAGE WORK ACTIVITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HIPAA OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-908-6057
Mailing Address - Street 1:20 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1207
Mailing Address - Country:US
Mailing Address - Phone:610-543-3380
Mailing Address - Fax:
Practice Address - Street 1:10 FATIMA DR
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-4640
Practice Address - Country:US
Practice Address - Phone:610-543-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000031400002Medicaid