# DEVEREUX KANNER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kanner Jackson Villa
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306960091
- **Authorized official:** FRAN WAGNER (NATIONAL DIRECTOR, AR)
- **Authorized official phone:** (610) 542-3084

## Contact information

- **Practice address:** 390 E BOOT RD, 101 GENUARDI CIRCLE, WEST CHESTER, PA 19380-1222
- **Practice address phone:** (610) 431-8100
- **Practice address fax:** (610) 431-3155
- **Mailing address:** 2012 RENAISSANCE BLVD, KING OF PRUSSIA, PA 19406-2786
- **Mailing address phone:** (610) 542-3084
- **Mailing address fax:** (610) 542-3191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | 112050 | PA | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 132880 | PA | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 08/31/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0010537 | — | NJ |