DEVEREUX FOUNDATION COUNTRY CLUB NPI 1104949163

NPI Information

NPI: 1104949163
Provider Name: DEVEREUX FOUNDATION COUNTRY CLUB

Other Name: WHITLOCK COUNTRY CLUB

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
755 COUNTRY CLUB RD
PHOENIXVILLE, PA
ZIP 19460
Phone: (610) 296-6800
Get Directions

DEVEREUX FOUNDATION COUNTRY CLUB is an intermediate care facility mentally retarded in Phoenixville, PA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. DEVEREUX FOUNDATION COUNTRY CLUB NPI is 1104949163. The provider is registered as an organization entity type.
The provider Other Name Is Whitlock Country Club.

The provider's business location address is:

755 COUNTRY CLUB RD
PHOENIXVILLE, PA
ZIP 19460-725
Phone: (610) 296-6800
Fax: (610) 251-2013

The provider's authorized official is Fran Wagner .
The authorized official title is National Accts Receivable Director and has the following contact phone number (610) 542-3084.

The enumeration date for this NPI number is 4/6/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		504640	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1000019130308	MEDICAID	PENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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