Healthcare Provider Details

I. General information

NPI: 1629568712
Provider Name (Legal Business Name): DG CULTURAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JAMES WAY
SOUTHAMPTON PA
18966-3818
US

IV. Provider business mailing address

38 GLENFIELD DR
RICHBORO PA
18954-1315
US

V. Phone/Fax

Practice location:
  • Phone: 215-518-9998
  • Fax:
Mailing address:
  • Phone: 215-518-9998
  • Fax: 215-396-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID GVINIANIDZE
Title or Position: PRESIDENT
Credential:
Phone: 215-518-9998