Healthcare Provider Details

I. General information

NPI: 1225536568
Provider Name (Legal Business Name): DELAWARE VALLEY COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ALLEGHENY AVE BLDG 5B
PHILADELPHIA PA
19133-3639
US

IV. Provider business mailing address

1412 22 FAIRMOUNT AVENUE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-2500
  • Fax: 215-291-2582
Mailing address:
  • Phone: 215-684-5344
  • 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: DR. ALVAN SCOTT MCNEAL
Title or Position: PRESIDENT/CEO
Credential: DO
Phone: 215-684-5344