Provider Demographics
NPI:1427413335
Name:THE DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:THE DEVEREUX FOUNDATION
Other - Org Name:GABLES
Other - Org Type:Other Name
Authorized Official - Title/Position:REIMBURSEMENTT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-542-3042
Mailing Address - Street 1:228 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1451
Mailing Address - Country:US
Mailing Address - Phone:610-542-3042
Mailing Address - Fax:
Practice Address - Street 1:228 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1451
Practice Address - Country:US
Practice Address - Phone:610-542-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA193080323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility