NPIMap

Organization Active NPI

Devereux Kanner

  • Mental Illness Community Based Residential Treatment Facility
  • West Chester, PA
National Provider Identifier
1164546644
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
112070 Issued in PA
Legal business name
DEVEREUX KANNER
Practice address
390 E Boot Rd
West Chester, PA 19380-1222
Phone
(610) 431-8100
Fax
(610) 431-3155
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Fran Wagner
Title
National Director, Ar
Phone
(610) 542-3084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 112070 PA Primary

Addresses

Primary practice location

390 E Boot Rd
West Chester, PA 19380-1222

Mailing address

2012 Renaissance Blvd
King of Prussia, PA 19406-2786
Phone (610) 542-3084

Other identifiers 1

IdentifierTypeStateIssuer
0010464MedicaidNJ

Other names 1

  • Kanner Laura Villa Other name

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164546644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 RENAISSANCE BLVD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062786",
            "telephone_number": "610-542-3084",
            "fax_number": "610-542-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 E BOOT RD",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193801222",
            "telephone_number": "610-431-8100",
            "fax_number": "610-431-3155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVEREUX KANNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "FRAN",
        "authorized_official_title_or_position": "NATIONAL DIRECTOR, AR",
        "authorized_official_telephone_number": "610-542-3084"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "PA",
            "license": "112070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010464",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kanner Laura Villa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.