Organization
DEVEREUX FOUNDATION COUNTRY CLUB
Active
Other names
Whitlock Country Club
Organization subpart
No
Provider details
NPI number
Authorized official
FRAN WAGNER (NATIONAL ACCTS RECEIVABLE DIRECTOR)
(610) 542-3084
Entity
Organization
Contact information
Practice address
755 COUNTRY CLUB RD, PHOENIXVILLE, PA 19460-2725
(610) 296-6800
(610) 251-2013
Mailing address
2012 RENAISSANCE BLVD, KING OF PRUSSIA, PA 19406-2786
(610) 542-3084
(610) 542-3191
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
504640
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000019130308
—
PA
Enumeration date
04/06/2007
Last updated
08/22/2020
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