MEDICARE: DG CULTURAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center
2	261QA0600X	Adult Day Care Clinic/Center		PA

General Provider Information

NPI Number	:	1629568712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DG CULTURAL CENTER, INC.

Provider Business Mailing Address
First Line	:	38 GLENFIELD DR
Second Line	:
City	:	RICHBORO
State	:	PA
Zip	:	18954-1315
Country	:	US
Telephone Number	:	215-518-9998
Fax Number	:	215-396-6650

Provider Business Practice Location Address
First Line	:	150 JAMES WAY
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3818
Country	:	US
Telephone Number	:	215-518-9998
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID GVINIANIDZE
Credential	:
Telephone Number	:	215-518-9998

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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Directions to “DG CULTURAL CENTER, INC. ” Practice Location

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