Provider Demographics
NPI:1518435114
Name:COMMUNITY SERVICES OF DEVEREUX
Entity Type:Organization
Organization Name:COMMUNITY SERVICES OF DEVEREUX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-422-1463
Mailing Address - Street 1:100 DEERFIELD LN STE 100
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2100
Mailing Address - Country:US
Mailing Address - Phone:610-933-8110
Mailing Address - Fax:610-933-7451
Practice Address - Street 1:100 DEERFIELD LN STE 100
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2100
Practice Address - Country:US
Practice Address - Phone:610-933-8110
Practice Address - Fax:610-933-7451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVEREUX FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-13
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000019130441Medicaid