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General NPI Number Information
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NPI Number | 1497852768
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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 | 09/20/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 6436 E SWEETWATER AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4581
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Country | US
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Telephone | 480-998-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 N CENTRAL AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85012-3520
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Country | US
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Telephone | 602-283-1573
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Fax | 480-443-5587
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YVETTE JACKSON
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Credential |
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Telephone | 520-576-5765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | BH-246
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License Number State | AZ
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