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General NPI Number Information
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NPI Number | 1639656705
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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 | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 124 WERTSVILLE RD
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-3908
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Country | US
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Telephone | 856-599-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 286 MANTUA GROVE RD BLDG 4
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City | WEST DEPTFORD
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State | NJ
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Zip | 08066-1738
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Country | US
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Telephone | 856-599-6400
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Fax | 856-599-6406
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Authorized Official
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Title or Position | ASSISTANT FINANCE DIRECTOR
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Name | PAUL MCNEILL
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Credential |
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Telephone | 856-599-6230
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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 | GH0970
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License Number State | NJ
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