Organization
DEVEREUX CLEO WALLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE WRIGHT (QUALITY IMPROVEMENT DIRECTOR)
(303) 438-2265
Entity
Organization
Contact information
Practice address
8405 CHURCH RANCH BLVD, WESTMINSTER, CO 80021-3918
(303) 466-7391
Mailing address
8405 CHURCH RANCH BLVD, WESTMINSTER, CO 80021-3918
(303) 466-7391
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
39794
CO
323P00000X
Psychiatric Residential Treatment Facility
39794
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05350053
—
CO
05
—
17284554
—
CO
Enumeration date
09/21/2006
Last updated
03/11/2022
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