1689873911 NPI number — DELAWARE VALLEY COMMUNITY HEALTH, INC.

Table of content: (NPI 1689873911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689873911 NPI number — DELAWARE VALLEY COMMUNITY HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE VALLEY COMMUNITY HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689873911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19130-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-235-9600
Provider Business Mailing Address Fax Number:
215-232-4093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 E HUNTING PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-537-7695
Provider Business Practice Location Address Fax Number:
215-537-7001
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEAL
Authorized Official First Name:
ALVAN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
215-684-5344

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100772996-0023 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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