Provider Demographics
NPI:1609055821
Name:DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:THE DEVEREUX FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD CONTRACTS ANALYST
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 1:1300 SHIP RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1308
Mailing Address - Country:US
Mailing Address - Phone:610-431-9651
Mailing Address - Fax:610-542-3191
Practice Address - Street 1:1300 SHIP RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1308
Practice Address - Country:US
Practice Address - Phone:610-431-9651
Practice Address - Fax:610-542-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000019130348Medicaid