Healthcare Provider Details

I. General information

NPI: 1073819967
Provider Name (Legal Business Name): DELAWARE VALLEY COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W GIRARD AVE SUITE 201
PHILADELPHIA PA
19130-1615
US

IV. Provider business mailing address

1412 FAIRMOUNT AVE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 215-827-8010
  • Fax: 215-765-2191
Mailing address:
  • Phone: 215-599-4851
  • Fax: 215-232-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA DEITCH
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 215-235-9600