1518930650 NPI number — DEVEREUX FOUNDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518930650 NPI number — DEVEREUX FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVEREUX FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEVEREUX TEXAS TREATMENT NETWORK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518930650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 DEVEREUX DR
Provider Second Line Business Mailing Address:
OUTPATIENT CLINIC
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-332-8608
Provider Business Mailing Address Fax Number:
281-332-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 DEVEREUX DR
Provider Second Line Business Practice Location Address:
OUTPATIENT CLINIC
Provider Business Practice Location Address City Name:
LEAGUE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77573-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-332-8608
Provider Business Practice Location Address Fax Number:
281-332-5283
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HELM
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
281-335-1000

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: TMHP083851801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 083851801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000718 . This is a "HOSPITAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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