Provider Demographics
NPI:1629568712
Name:DG CULTURAL CENTER, INC.
Entity type:Organization
Organization Name:DG CULTURAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GVINIANIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-518-9998
Mailing Address - Street 1:38 GLENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1315
Mailing Address - Country:US
Mailing Address - Phone:215-518-9998
Mailing Address - Fax:215-396-6650
Practice Address - Street 1:150 JAMES WAY
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3818
Practice Address - Country:US
Practice Address - Phone:215-518-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
PA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care