Provider Demographics
NPI:1992108153
Name:THE DEVEREUX FOUNDATION
Entity type:Organization
Organization Name:THE DEVEREUX FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-335-1000
Mailing Address - Street 1:1150 DEVEREUX DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2043
Mailing Address - Country:US
Mailing Address - Phone:281-335-1000
Mailing Address - Fax:281-554-7447
Practice Address - Street 1:1150 DEVEREUX DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2043
Practice Address - Country:US
Practice Address - Phone:281-335-1000
Practice Address - Fax:281-554-7447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DEVEREUX FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000718282E00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0212144Medicaid
TX1235212895OtherINITIAL NPI FOR RESIDENTIAL
TX454085OtherMEDICARE PTAN