Organization
DEVEREUX KANNER
Active
Other names
Greenway Program
Organization subpart
No
Provider details
NPI number
Authorized official
FRAN WAGNER (NATIONAL DIRECTOR AR)
(610) 542-3084
Entity
Organization
Contact information
Practice address
390 E BOOT RD, WEST CHESTER, PA 19380-1222
(610) 431-8100
(610) 431-3155
Mailing address
2012 RENAISSANCE BLVD, KING OF PRUSSIA, PA 19406-2786
(610) 542-3084
(610) 542-3191
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
112090
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010472
—
NJ
Enumeration date
03/19/2007
Last updated
08/22/2020
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