Provider Demographics
NPI:1073819967
Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Entity Type:Organization
Organization Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Other - Org Name:FAIRMOUNT PRIMARY CARE CENTER AT ST. JOSEPH'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-235-9600
Mailing Address - Street 1:1412 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:1600 W GIRARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1615
Practice Address - Country:US
Practice Address - Phone:215-827-8010
Practice Address - Fax:215-765-2191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)