Healthcare Provider Details

I. General information

NPI: 1437813656
Provider Name (Legal Business Name): DEVEREUX FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E NEW YORK AVE STE C
DELAND FL
32724-5527
US

IV. Provider business mailing address

5850 T G LEE BLVD STE 400
ORLANDO FL
32822-4409
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-5543
  • Fax:
Mailing address:
  • Phone: 407-362-9210
  • Fax: 866-440-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MCKEEVER
Title or Position: NATIONAL DIRECTOR OF AR
Credential:
Phone: 610-542-3064