Healthcare Provider Details

I. General information

NPI: 1356474977
Provider Name (Legal Business Name): DEVEREUX RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 GLENROSE DR
DURHAM NC
27703-2669
US

IV. Provider business mailing address

103 SETTLERS MILL LN
DURHAM NC
27713-8541
US

V. Phone/Fax

Practice location:
  • Phone: 919-806-9528
  • Fax: 919-321-1815
Mailing address:
  • Phone: 919-806-9528
  • Fax: 919-321-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMHL032284
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL032284
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL032284
License Number StateNC

VIII. Authorized Official

Name: MRS. NADINE WILLIAMS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 919-806-9528