MEDICARE: DIVINE PROVIDENCE VILLAGE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811015985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE PROVIDENCE VILLAGE

Provider Business Mailing Address
First Line	:	686 OLD MARPLE RD
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-1239
Country	:	US
Telephone Number	:	610-328-7730
Fax Number	:	610-544-1710

Provider Business Practice Location Address
First Line	:	4545 OAKMONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3703
Country	:	US
Telephone Number	:	610-543-5410
Fax Number	:	610-543-5397

Authorized Official
Title or Position	:	DIVISIONAL DIRECTOR
Name	:	MR. FRAN SWIACKI
Credential	:
Telephone Number	:	610-543-3380

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/16/2015

Similar Medicare Providers

1013987544 — JONATHAN M. COX M.D.
Practice Location Address:

10101 BUSTLETON AVE , SUITE C
PHILADELPHIA, PA
19116-3703

Practice Phone: 215-671-3920
Practice Fax: 215-671-3939

1215626858 — CREATING GREATER LIVING HOME CARE AGENCY LLC
Practice Location Address:

6018 N 10TH ST
PHILADELPHIA, PA
19141-3703

Practice Phone: 267-252-5868
Practice Fax:

1679440788 — TAHSINA MIAH
Practice Location Address:

2112 NAPFLE ST
PHILADELPHIA, PA
19152-3703

Practice Phone: 215-684-9681
Practice Fax:

1154280907 — CONSTANCE ROUX
Practice Location Address:

3703 W COUNTRY CLUB RD
PHILADELPHIA, PA
19131-2814

Practice Phone: 267-438-3494
Practice Fax:

1396677654 — MR. ABDALLAH ELHUSSIEN A ELHUSSIEN INTERPRETER
Practice Location Address:

4226 HARTEL AVE
PHILADELPHIA, PA
19136-3114

Practice Phone: 215-305-2996
Practice Fax: 215-305-2996

1891628012 — MADISON REMENTER
Practice Location Address:

8421 FRANKFORD AVE
PHILADELPHIA, PA
19136-2420

Practice Phone: 215-468-8333
Practice Fax:

Directions to “DIVINE PROVIDENCE VILLAGE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.