NPIMap

Organization Active NPI

The Devereux Foundation

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Deptford, NJ
National Provider Identifier
1801320494
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
GH754 Issued in NJ
Legal business name
THE DEVEREUX FOUNDATION
Practice address
105 Shelly Lane
Deptford, NJ 08096
Phone
(856) 599-6400
Fax
(856) 599-6404
NPI assigned
Apr 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Authorized official

Name
Ms. Carole Cirucci
Title
Director of Finance
Phone
(856) 599-6429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GH754 NJ Primary

Addresses

Primary practice location

105 Shelly Lane
Deptford, NJ 08096

Mailing address

286 Mantua Grove Road
West Deptford, NJ 08066
Phone (856) 599-6400

Other identifiers 1

IdentifierTypeStateIssuer
0399507MedicaidNJ

Other names 1

  • Devereux Advanced Behavioral Health Doing business as

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

Locations

105 Shelly Ln
Deptford, NJ 08096

NPI Registry JSON

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1801320494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 MANTUA GROVE ROAD",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "08066",
            "telephone_number": "856-599-6400",
            "fax_number": "856-599-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SHELLY LANE",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "08096",
            "telephone_number": "856-599-6400",
            "fax_number": "856-599-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DEVEREUX FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "CIRUCCI",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "856-599-6429",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "GH754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0399507",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devereux Advanced Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deptford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.