Provider Demographics
NPI:1174545115
Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Entity type:Organization
Organization Name:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALVAN
Authorized Official - Middle Name:SCOTT MCNEAL
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-684-5344
Mailing Address - Street 1:1412-22 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-684-5344
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:1401 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3405
Practice Address - Country:US
Practice Address - Phone:610-278-7787
Practice Address - Fax:610-278-7386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE VALLEY COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007729960024Medicaid
PA391901Medicare Oscar/Certification