NPIMap

Organization Active NPI

The Devereux Foundation

  • Community Health Clinic/Center
  • Davie, FL
National Provider Identifier
1104980259
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
THE DEVEREUX FOUNDATION
Practice address
4801 S University Dr Ste 134
Davie, FL 33328-3860
Phone
(954) 731-7665
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gwen Skinner
Title
Executive Director
Phone
(407) 362-9210

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4801 S University Dr Ste 134
Davie, FL 33328-3860

Mailing address

5850 T G Lee Blvd Ste 400
Orlando, FL 32822-4409
Phone (407) 812-4555

Other identifiers 2

IdentifierTypeStateIssuer
767753700MedicaidFL
767753701MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Devereux Florida331 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

1152 N University Dr
Ste 200
Pembroke Pines, FL 33024
Phone (954) 962-1225

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1104980259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 T G LEE BLVD STE 400",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328224409",
            "telephone_number": "407-812-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 S UNIVERSITY DR STE 134",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283860",
            "telephone_number": "954-731-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DEVEREUX FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "SKINNER",
        "authorized_official_first_name": "GWEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "407-362-9210"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767753700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767753701",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.