Provider Demographics
NPI:1356969679
Name:DEVEREUX FOUNDATION
Entity type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-542-3042
Mailing Address - Street 1:390 EAST BOOT ROAD
Mailing Address - Street 2:100 GENUARDI CIRCLE
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-431-8000
Mailing Address - Fax:
Practice Address - Street 1:100 GENUARDI CIRCLE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-431-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities