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General NPI Number Information
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NPI Number | 1124189386
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Entity Type | Organization
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Legal Business Name | DEVEREUX FOUNDATION
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 390 E BOOT RD
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City | WEST CHESTER
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State | PA
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Zip | 19380-1222
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Country | US
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Telephone | 610-431-8100
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Fax | 610-431-8191
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Provider Business Mailing Address
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Address Line | 390 E BOOT RD
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City | WEST CHESTER
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State | PA
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Zip | 19380-1222
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Country | US
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Telephone | 610-431-8100
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Fax | 610-431-8191
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Authorized Official
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Title or Position | NATIONAL DIRECTOR, AR
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Name | MS. FRAN WAGNER
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Credential |
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Telephone | 610-542-3084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 188810
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 126010
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | PA
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