Healthcare Provider Details

I. General information

NPI: 1154797454
Provider Name (Legal Business Name): DEVEREUX FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 N CAMINO MIRA MONTE
TUCSON AZ
85716-4230
US

IV. Provider business mailing address

6141 E GRANT RD BLDG A
TUCSON AZ
85712-5829
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-5551
  • Fax:
Mailing address:
  • Phone: 480-889-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. YVETTE JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 520-370-5207