DIVINE PROVIDENCE VILLAGE (NPI# 1649635715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649635715 |
| Entity Type | Organization |
| Organization Name | DIVINE PROVIDENCE VILLAGE |
| Practice Address |
119 State Rd Apt. G-8 Media PA 19063-1582 |
| Mailing Address |
686 Old Marple Rd Springfield PA 19064-1239 |
| Practice Telephone | 6105433380 |
| Mailing Telephone | 6103287730 |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |
| Authorized Official Name | MR. FRAN SWIACKI (DIVISIONAL DIRECTOR) |
| Authorized Official Telephone | 6105433380 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699130237 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 19 James Rd, Broomall, PA 19008-1409 | 2015-12-28 |
| 1235594870 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8 Hinkson Blvd, Ridley Park, PA 19078-1828 | 2015-12-28 |
| 1144685785 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 58 Shelburne Rd, Springfield, PA 19064-2206 | 2015-12-28 |
| 1598120131 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 708 Bullock Ave, Yeadon, PA 19050-3501 | 2015-12-28 |
| 1780049320 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 215 Fairlamb Ave, Havertown, PA 19083-2822 | 2015-12-28 |
| 1871958413 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 33 S Madison Ave, Upper Darby, PA 19082-2818 | 2015-12-28 |
| 1154786796 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 202 E Maryland Ave, Aldan, PA 19018-3117 | 2015-12-28 |
| 1053776690 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1712 Shallcross Ave, Folcroft, PA 19032-1225 | 2015-12-28 |
| 1811352701 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 41 Media Line Rd, Apt. A-2, Broomall, PA 19008-1246 | 2015-12-21 |
| 1629433511 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 410 E Hinckley Ave, Apt. A-6, Ridley Park, PA 19078-2521 | 2015-12-21 |
| Street Address |
119 STATE RD APT. G-8 |
| City | MEDIA |
| State | PA |
| Zip Code | 19063-1582 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538766837 | Kimberly Ann Martyn | Nurse Practitioner | 168 W Baltimore Pike, Media, PA 19063 | 2020-10-08 |
| 1366060220 | Yinka Read | Clinical Neuropsychologist | 1088 W. Baltimore Pike, Healthcare II, Suite 2205, Media, PA 19063 | 2020-07-08 |
| 1306304522 | Caroline Dickerson | Speech-Language Pathologist | 510 Williamson Cir, Media, PA 19063 | 2019-03-06 |
| 1528544178 | Dayeon Cho | Nurse Practitioner | 1400 North Providence Road, Suite 1020, Rose Tree Corporate Center, Building 2, Media, PA 19063 | 2018-07-17 |
| 1235621400 | Joseph Savukinas | Registered Nurse | Mirmont Treatment Center, 100 Yearsley Mill Rd, Media, PA 19063 | 2018-06-04 |
| 1003331281 | Accredited Environmental Technologies, Inc. | Contractor | 28 N. Pennell Road, Media, PA 19063 | 2017-08-08 |
| 1538684220 | Holcomb Associates Inc. | Clinic/Center | 126 East Baltimore Pike, Gayley Square, Media, PA 19063 | 2017-08-03 |
| 1619498334 | Bryan Allen Mizell | Specialist/Technologist | 324 Crestview Circle, Media, PA 19063 | 2017-07-03 |
| 1427597970 | Grow Now Therapy Services LLC. | Speech-Language Pathologist | 600 N Jackson Street, Media, PA 19063 | 2017-02-16 |
| 1720520216 | Kathryn Rauch | Counselor | 107 Chesley Drive Unit #5, Media, PA 19063 | 2016-11-15 |
| Find all providers in zip 19063 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952775736 | Communities of Don Guanella and Divine Providence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 21 War Admiral Ln, Media, PA 19063-5240 | 2015-11-17 |
| 1801914585 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 620 N Monroe St, Media, PA 19063-2506 | 2007-03-27 |
| 1841317104 | Communities of Don Guanella and Divine Providence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 850 Pickering Ln, Media, PA 19063-1317 | 2007-03-23 |
| 1679692925 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 441 Washington Ave, Media, PA 19063-3923 | 2007-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356940183 | Kenccid | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9350 Ashton Rd Rm 202, Philadelphia, PA 19114-7402 | 2020-10-22 |
| 1952908618 | Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 604 Glen Circle Dr, Tobyhanna, PA 18466-8300 | 2020-10-06 |
| 1598375305 | Impactful Human Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1055 Westlakes Dr Ste 3003, Berwyn, PA 19312-2410 | 2020-08-06 |
| 1356969679 | Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 100 Genuardi Circle, West Chester, PA 19380 | 2020-07-13 |
| 1437775442 | The Arc of Crawford County, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 222 Chestnut St, Meadville, PA 16335-3407 | 2020-06-25 |
| 1568094142 | Keystone Community Resources, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1768 Mcdonough Ave, Scranton, PA 18508-1566 | 2020-02-11 |
| 1114559267 | Keystone Community Resources, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 336 Sheridan Ave, Clarks Summit, PA 18411-1458 | 2020-02-06 |
| 1619507332 | Above & Beyond Berks LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1007 Saylor Dr, Temple, PA 19560-9587 | 2020-01-22 |
| 1700425287 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 639 N South Turnpike Rd, Newfoundland, PA 18445-5032 | 2019-12-31 |
| 1891331120 | Gifted Hands Home Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1853 William Penn Way Ste 13, Lancaster, PA 17601-6713 | 2019-11-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.