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General NPI Number Information
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NPI Number | 1386781359
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Entity Type | Organization
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Legal Business Name | THE DEVEREUX FOUNDATION
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 286 MANTUA GROVE RD BUIDLING 4
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City | PAULSBORO
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State | NJ
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Zip | 08066-1731
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Country | US
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Telephone | 856-599-6400
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Fax | 856-599-6401
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Provider Business Mailing Address
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Address Line | 286 MANTUA GROVE RD BUIDLING 4
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City | PAULSBORO
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State | NJ
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Zip | 08066-1731
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Country | US
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Telephone | 856-599-6400
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Fax | 856-599-6401
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Authorized Official
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Title or Position | NATIONAL ACCOUNTS RECEIVABLE DIRECT
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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 | 3000-035
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License Number State | NJ
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