Provider Demographics
NPI:1790376275
Name:DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR ACCTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-542-3064
Mailing Address - Street 1:PO BOX 74292
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:520-721-7656
Mailing Address - Fax:
Practice Address - Street 1:7444 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1411
Practice Address - Country:US
Practice Address - Phone:520-721-7656
Practice Address - Fax:520-296-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness