Provider Demographics
NPI:1437524972
Name:DEVEREUX ARIZONA
Entity Type:Organization
Organization Name:DEVEREUX ARIZONA
Other - Org Name:DEVEREUX FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-576-5598
Mailing Address - Street 1:6141 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5829
Mailing Address - Country:US
Mailing Address - Phone:520-576-5598
Mailing Address - Fax:520-296-8244
Practice Address - Street 1:6141 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5829
Practice Address - Country:US
Practice Address - Phone:520-576-5598
Practice Address - Fax:520-296-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-721385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729634Medicaid