Provider Demographics
NPI:1245682673
Name:DEVERUEX
Entity type:Organization
Organization Name:DEVERUEX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADULT FOSTER CARE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-438-5338
Mailing Address - Street 1:22958 W GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6230
Mailing Address - Country:US
Mailing Address - Phone:480-438-5338
Mailing Address - Fax:
Practice Address - Street 1:22958 W GARDENIA DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6230
Practice Address - Country:US
Practice Address - Phone:480-438-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1033425368OtherACCCHS