Organization
DEVEREUX KANNER
Active
Other names
Kanner Brumer 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, 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
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
126010
PA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
126010
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010481
—
NJ
Enumeration date
03/19/2007
Last updated
06/10/2011
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