NPIMap

Organization Active NPI

Devereux Kanner

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • West Chester, PA
National Provider Identifier
1306960091
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
132880 Issued in PA
Legal business name
DEVEREUX KANNER
Practice address
390 E Boot Rd
101 Genuardi Circle
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 31, 2010

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 112050 PA
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 132880 PA Primary

Addresses

Primary practice location

390 E Boot Rd
101 Genuardi Circle
West Chester, PA 19380-1222

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0010537MedicaidNJ

Other names 1

  • Kanner Jackson 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": "1283212800000",
    "number": "1306960091",
    "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",
            "address_2": "101 GENUARDI CIRCLE",
            "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": "2010-08-31",
        "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": "112050",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "PA",
            "license": "132880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010537",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kanner Jackson 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 31, 2010; 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.