MEDICARE: DELAWARE VALLEY RESIDENTIAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QR0400X	Rehabilitation Clinic/Center
3	311ZA0620X	Adult Care Home Facility
4	320800000X	Mental Illness Community Based Residential Treatment Facility
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700143740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE VALLEY RESIDENTIAL CARE LLC

Provider Business Mailing Address
First Line	:	1430 DEKALB ST
Second Line	:	3RD FLOOR
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-3406
Country	:	US
Telephone Number	:	484-681-4697
Fax Number	:	484-674-7039

Provider Business Practice Location Address
First Line	:	280 JACKSONVILLE RD
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-4425
Country	:	US
Telephone Number	:	484-681-4697
Fax Number	:	484-674-7039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES F. O'CONNOR
Credential	:
Telephone Number	:	484-681-4697

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/19/2019

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