1750443990 NPI number — THE DEVEREUX FOUNDATION

Table of content: (NPI 1750443990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750443990 NPI number — THE DEVEREUX FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE 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:
Provider Other Organization Name Type Code:
6
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:
1750443990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 SUGARTOWN RD, BOX 275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-0275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-935-6789
Provider Business Mailing Address Fax Number:
610-251-2415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 SUGARTOWN RD, BOX 275
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALVERN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-0275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-935-6789
Provider Business Practice Location Address Fax Number:
610-251-2415
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNNE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
610-542-3063

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  117220 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0002464002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195845300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8385904 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019199800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000019130419 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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