Organization
THE DEVEREUX FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWEN SKINNER (VICE PRESIDENT OF OPERATIONS)
(407) 362-9210
Entity
Organization
Contact information
Practice address
1850 S DELEON AVE, TITUSVILLE, FL 32780-7733
(407) 374-2827
Mailing address
5850 T.G. LEE BOULEVARD, SUITE 400, ORLANDO, FL 32822
(407) 812-4555
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029573615
—
FL
Enumeration date
12/06/2006
Last updated
11/06/2018
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