Provider Demographics
NPI:1083168322
Name:DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:DEVEREUX ARIZONA - CFS MESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-283-1573
Mailing Address - Street 1:2025 N 3RD ST
Mailing Address - Street 2:#250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1471
Mailing Address - Country:US
Mailing Address - Phone:480-889-0566
Mailing Address - Fax:
Practice Address - Street 1:1837 S MESA DR
Practice Address - Street 2:#A-201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6246
Practice Address - Country:US
Practice Address - Phone:602-283-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health