Provider Demographics
NPI:1811361447
Name:DIVINE PROVIDENCE VILLAGE
Entity Type:Organization
Organization Name:DIVINE PROVIDENCE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-543-3380
Mailing Address - Street 1:686 OLD MARPLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1239
Mailing Address - Country:US
Mailing Address - Phone:610-328-7730
Mailing Address - Fax:
Practice Address - Street 1:2825 W OXFORD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2743
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:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities