Provider Demographics
NPI:1902370570
Name:DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANACE
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-839-6151
Mailing Address - Street 1:1547 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-5239
Mailing Address - Country:US
Mailing Address - Phone:570-839-6151
Mailing Address - Fax:570-676-4586
Practice Address - Street 1:122 LEOPARD RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1809
Practice Address - Country:US
Practice Address - Phone:570-839-6151
Practice Address - Fax:570-676-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities