=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144137951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEVEREUX ADVANCED BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 SUNHAVEN DR
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08312-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-599-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 LINCOLN DR W
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-846-8987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACT MANAGER
-----------------------------------------------------
Name | JESSICA KALBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-542-3042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------