Healthcare Provider Details

I. General information

NPI: 1700143740
Provider Name (Legal Business Name): DELAWARE VALLEY RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 JACKSONVILLE RD
WARMINSTER PA
18974-4425
US

IV. Provider business mailing address

1430 DEKALB ST 3RD FLOOR
NORRISTOWN PA
19401-3406
US

V. Phone/Fax

Practice location:
  • Phone: 484-681-4697
  • Fax: 484-674-7039
Mailing address:
  • Phone: 484-681-4697
  • Fax: 484-674-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES F. O'CONNOR
Title or Position: PRESIDENT
Credential:
Phone: 484-681-4697