Provider Demographics
NPI:1114940582
Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Entity Type:Organization
Organization Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Other - Org Name:MARIA DE LOS SANTOS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALVAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-684-5344
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:214-291-2500
Practice Address - Street 1:401 55 W ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3644
Practice Address - Country:US
Practice Address - Phone:215-291-2500
Practice Address - Fax:215-291-2587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007729960022Medicaid
PA1007729960022Medicaid