Provider Demographics
NPI:1467131284
Name:DRYDEN COMMUNITY HOMES, LLC
Entity type:Organization
Organization Name:DRYDEN COMMUNITY HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-310-5055
Mailing Address - Street 1:749 SPRING MILL AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1953
Mailing Address - Country:US
Mailing Address - Phone:610-310-5055
Mailing Address - Fax:
Practice Address - Street 1:749 SPRING MILL AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1953
Practice Address - Country:US
Practice Address - Phone:610-310-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities