Provider Demographics
NPI:1528835634
Name:DEVEREUX FOUNDATION
Entity type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR OF ACCOUNTS REC
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-637-4536
Mailing Address - Street 1:5850 T G LEE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4409
Mailing Address - Country:US
Mailing Address - Phone:407-362-9210
Mailing Address - Fax:
Practice Address - Street 1:3550 N GOLDENROD RD STE 1
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8823
Practice Address - Country:US
Practice Address - Phone:321-441-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty