NPIMap

Organization Active NPI

Devereux Cleo Wallace

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Westminster, CO
National Provider Identifier
1184723660
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
39794 Issued in CO
Legal business name
DEVEREUX CLEO WALLACE
Practice address
8405 Church Ranch Blvd
Westminster, CO 80021-3918
Phone
(303) 466-7391
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Authorized official

Name
Bonnie Wright
Title
Quality Improvement Director
Phone
(303) 438-2265

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 39794 CO Primary
Psychiatric Residential Treatment Facility 323P00000X 39794 CO

Addresses

Primary practice location

8405 Church Ranch Blvd
Westminster, CO 80021-3918

Mailing address

8405 Church Ranch Blvd
Westminster, CO 80021-3918
Phone (303) 466-7391

Other identifiers 2

IdentifierTypeStateIssuer
05350053MedicaidCO
17284554MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Devereux Cleo Wallace4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1184723660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 CHURCH RANCH BLVD",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800213918",
            "telephone_number": "303-466-7391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 CHURCH RANCH BLVD",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800213918",
            "telephone_number": "303-466-7391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVEREUX CLEO WALLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "QUALITY IMPROVEMENT DIRECTOR",
        "authorized_official_telephone_number": "303-438-2265"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CO",
            "license": "39794",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CO",
            "license": "39794",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05350053",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17284554",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; 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.