# DEVEREUX CLEO WALLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184723660
- **Authorized official:** BONNIE WRIGHT (QUALITY IMPROVEMENT DIRECTOR)
- **Authorized official phone:** (303) 438-2265

## Contact information

- **Practice address:** 8405 CHURCH RANCH BLVD, WESTMINSTER, CO 80021-3918
- **Practice address phone:** (303) 466-7391
- **Mailing address:** 8405 CHURCH RANCH BLVD, WESTMINSTER, CO 80021-3918
- **Mailing address phone:** (303) 466-7391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 39794 | CO | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | 39794 | CO | — |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 03/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05350053 | — | CO |
| 05 | — | 17284554 | — | CO |