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DEVEREUX FOUNDATION NPI 1346319142


NPI Information

NPI: 1346319142
Provider Name: DEVEREUX FOUNDATION

Other Name: DEVEREUX GEORGIA TREATMENT NETWORK

Classification: Psychiatric Residential Treatment Facility - 323P00000X
Entity Type: Organization
Address:
1291 STANLEY RD NW
KENNESAW, GA
ZIP 30152
Phone: (770) 427-0147
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DEVEREUX FOUNDATION is a psychiatric residential treatment facility in Kennesaw, GA. The provider is a residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary DEVEREUX FOUNDATION NPI is 1346319142. The provider is registered as an organization entity type.
The provider Other Name Is Devereux Georgia Treatment Network.

The provider's business location address is:

1291 STANLEY RD NW
KENNESAW, GA
ZIP 30152-359
Phone: (770) 427-0147

The provider's authorized official is Mario Bolivar .
The authorized official title is Executive Director and has the following contact phone number (687) 303-2669.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 1/16/2009.


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
1323P00000XPsychiatric Residential Treatment Facility5910GEORGIAYes

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
13404521MEDICAIDNORTH CAROLINA
2087592297AMEDICAIDGEORGIA
30002464004MEDICAIDWEST VIRGINIA
4700401000MEDICAIDMARYLAND
5019200400MEDICARE ID-TYPE UNSPECIFIEDDISTRICT OF COLUMBIADC MEDICAID
68387605MEDICARE ID-TYPE UNSPECIFIEDNEW JERSEYNJ MEDICAID

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

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