MEDICARE: DEVEREUX FOUNDATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578039954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVEREUX FOUNDATION

Provider Business Mailing Address
First Line	:	2025 N 3RD ST STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1472
Country	:	US
Telephone Number	:	480-443-5590
Fax Number	:

Provider Business Practice Location Address
First Line	:	11024 N 28TH DR STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4378
Country	:	US
Telephone Number	:	602-944-6222
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LANE MARTIN-BARKER
Credential	:
Telephone Number	:	602-283-1573

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/23/2018

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Directions to “DEVEREUX FOUNDATION ” Practice Location

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