Healthcare Provider Details

I. General information

NPI: 1124189386
Provider Name (Legal Business Name): DEVEREUX FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 E BOOT RD
WEST CHESTER PA
19380-1222
US

IV. Provider business mailing address

390 E BOOT RD
WEST CHESTER PA
19380-1222
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-8100
  • Fax: 610-431-8191
Mailing address:
  • Phone: 610-431-8100
  • Fax: 610-431-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number188810
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number126010
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StatePA

VIII. Authorized Official

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