Provider Demographics
NPI:1518183383
Name:DPCH, LLC
Entity Type:Organization
Organization Name:DPCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-761-2508
Mailing Address - Street 1:4818 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:404-761-2644
Practice Address - Street 1:4818 OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6233
Practice Address - Country:US
Practice Address - Phone:404-761-2508
Practice Address - Fax:404-761-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891591BMedicaid
GA000891591AMedicaid