Organization
DEVEREUX KANNER
Active
Other names
Kanner Jackson Villa
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, 101 GENUARDI CIRCLE, 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
112050
PA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
132880
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010537
—
NJ
Enumeration date
03/19/2007
Last updated
08/31/2010
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