Provider Demographics
NPI:1942519376
Name:THE DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:THE DEVEREUX FOUNDATION
Other - Org Name:DEVEREUX ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-998-2920
Mailing Address - Street 1:11000 N SCOTTSDALE RD
Mailing Address - Street 2:STE 260
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6130
Mailing Address - Country:US
Mailing Address - Phone:480-998-2920
Mailing Address - Fax:480-443-5587
Practice Address - Street 1:6439 E EUGIE TER
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3963
Practice Address - Country:US
Practice Address - Phone:480-998-2920
Practice Address - Fax:480-443-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3649385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child