Provider Demographics
NPI:1750443990
Name:THE DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:THE DEVEREUX FOUNDATION
Other - Org Name:MAPLETON RTF
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-542-3063
Mailing Address - Street 1:655 SUGARTOWN RD, BOX 275
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0275
Mailing Address - Country:US
Mailing Address - Phone:800-935-6789
Mailing Address - Fax:610-251-2415
Practice Address - Street 1:655 SUGARTOWN RD, BOX 275
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-0275
Practice Address - Country:US
Practice Address - Phone:800-935-6789
Practice Address - Fax:610-251-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117220323P00000X
PA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002464002Medicaid
MD195845300Medicaid
NJ8385904Medicaid
DC019199800Medicaid
PA1000019130419Medicaid