MEDICARE: DEVEREUX RESIDENTIAL SERVICES LLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL032284	NC
2	251B00000X	Case Management Agency	MHL032284	NC
3	251S00000X	Community/Behavioral Health Agency	MHL032284	NC

General Provider Information

NPI Number	:	1356474977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVEREUX RESIDENTIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	103 SETTLERS MILL LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-8541
Country	:	US
Telephone Number	:	919-806-9528
Fax Number	:	919-321-1815

Provider Business Practice Location Address
First Line	:	1024 GLENROSE DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2669
Country	:	US
Telephone Number	:	919-806-9528
Fax Number	:	919-321-1815

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MRS. NADINE WILLIAMS
Credential	:
Telephone Number	:	919-806-9528

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	09/11/2025

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