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Devereux Foundation Whitlock

Organization Active NPI Developmental Disabilities Clinic/Center · Berwyn, PA

NPI 1609908375 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1609908375
Entity type
Organization (NPI type 2)
Primary specialty
Developmental Disabilities Clinic/Center 261QD1600X
License
104270 (PA)
Legal business name
DEVEREUX FOUNDATION WHITLOCK
Practice address
121 Leopard Rd
Berwyn, PA 19312-1809
Phone
(610) 296-6800
Fax
(610) 251-2013
NPI assigned
Mar 9, 2007
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Devereux Florida (331 organizations share this tax ID)

Locations

121 Leopard Rd
Berwyn, PA 19312
Phone (610) 296-6800

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X 104270 PA Yes
Developmental Disabilities Clinic/Center 261QD1600X 123180 PA

Addresses

Primary practice location

121 Leopard Rd
Berwyn, PA 19312-1809

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
100001913-0242MedicaidPA
100001913-0268MedicaidPA

Other names

  • Whitlock Vocational Services Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609908375",
    "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": "121 LEOPARD RD",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193121809",
            "telephone_number": "610-296-6800",
            "fax_number": "610-251-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVEREUX FOUNDATION WHITLOCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "FRAN",
        "authorized_official_title_or_position": "NATIONAL DIRECTOR, ACCTS RECEIVABLE",
        "authorized_official_telephone_number": "610-542-3084"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "PA",
            "license": "104270",
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "PA",
            "license": "123180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001913-0242",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001913-0268",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitlock Vocational Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berwyn, PA

All providers in Berwyn, PA · Developmental Disabilities Clinic/Center in Pennsylvania

Sources for this page

Verify at the official NPI Registry.