MEDICARE: DEVEREUX FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility	147344	MA

General Provider Information

NPI Number	:	1205052313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVEREUX FOUNDATION

Provider Business Mailing Address
First Line	:	60 MILES RD
Second Line	:
City	:	RUTLAND
State	:	MA
Zip	:	01543-1423
Country	:	US
Telephone Number	:	508-886-4746
Fax Number	:	508-886-2274

Provider Business Practice Location Address
First Line	:	60 MILES RD
Second Line	:
City	:	RUTLAND
State	:	MA
Zip	:	01543
Country	:	US
Telephone Number	:	508-886-4746
Fax Number	:	508-886-2274

Authorized Official
Title or Position	:	CONTRACTS MANAGER
Name	:	JESSICA KALBACH
Credential	:
Telephone Number	:	610-542-3042

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/17/2026

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Directions to “DEVEREUX FOUNDATION ” Practice Location

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