Provider Demographics
NPI:1689882243
Name:THE DEVEREUX FOUNDATION - CALIFORNIA
Entity Type:Organization
Organization Name:THE DEVEREUX FOUNDATION - CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-968-2525
Mailing Address - Street 1:PO BOX 6784
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6784
Mailing Address - Country:US
Mailing Address - Phone:805-968-2525
Mailing Address - Fax:
Practice Address - Street 1:7055 SEAWAY DR
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-4358
Practice Address - Country:US
Practice Address - Phone:805-968-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10497Medicare ID - Type Unspecified