Healthcare Provider Details

I. General information

NPI: 1578630018
Provider Name (Legal Business Name): DEVEREUX FOSTER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 W SHANGRI LA RD
GLENDALE AZ
85304-3851
US

IV. Provider business mailing address

5603 W SHANGRI LA RD
GLENDALE AZ
85304-3851
US

V. Phone/Fax

Practice location:
  • Phone: 623-979-1150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number11355
License Number StateAZ

VIII. Authorized Official

Name: MRS. MARIA ZAMBRANO
Title or Position: FOSTER PARENT
Credential:
Phone: 623-979-1150