# DEVEREUX FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Devereux Georgia Treatment Network
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346319142
- **Authorized official:** MR. MARIO BOLIVAR JR. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (687) 303-2669

## Contact information

- **Practice address:** 1291 STANLEY RD NW, KENNESAW, GA 30152-4359
- **Practice address phone:** (770) 427-0147
- **Mailing address:** 1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
- **Mailing address phone:** (770) 427-0147
- **Mailing address fax:** (770) 423-1502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | 5910 | GA | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 01/16/2009