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General NPI Number Information
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NPI Number | 1619031754
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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 | 12/21/2006
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 704 GENERATION PT STE 301
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City | KISSIMMEE
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State | FL
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Zip | 34744-5918
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Country | US
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Telephone | 407-935-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 T G LEE BLVD STE 400
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City | ORLANDO
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State | FL
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Zip | 32822-4409
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Country | US
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Telephone | 407-812-4555
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAEL C BECKER
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Credential |
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Telephone | 407-812-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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