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General NPI Number Information
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NPI Number | 1083478325
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Entity Type | Organization
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Legal Business Name | DIVINE PROVIDENCE HEALTHCARE, LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 515 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1461
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Country | US
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Telephone | 215-954-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W GIRARD AVE APT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1461
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Country | US
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Telephone | 215-954-7181
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN NWANONENYI
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Credential |
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Telephone | 215-954-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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