Provider Demographics
NPI:1073257200
Name:DEVEREUX ADVANCED BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:DEVEREUX ADVANCED BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-542-3042
Mailing Address - Street 1:160 DEVEREUX RD
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-1615
Mailing Address - Country:US
Mailing Address - Phone:484-595-6778
Mailing Address - Fax:
Practice Address - Street 1:160 DEVEREUX RD
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-1615
Practice Address - Country:US
Practice Address - Phone:484-595-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001913Medicaid
PA148170OtherLICENSE