Healthcare Provider Details

I. General information

NPI: 1902132111
Provider Name (Legal Business Name): THE DEVEREUX FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 MANTUA GROVE RD BUILDING 4
WEST DEPTFORD NJ
08066-1738
US

IV. Provider business mailing address

286 MANTUA GROVE RD BUILDING 4
WEST DEPTFORD NJ
08066-1738
US

V. Phone/Fax

Practice location:
  • Phone: 856-599-6400
  • Fax: 856-599-6401
Mailing address:
  • Phone: 856-599-6400
  • Fax: 856-599-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. FRAN WAGNER
Title or Position: NATIONAL DIRECTOR AR
Credential:
Phone: 610-542-3084