Devereux Cleo Wallace, NPI 1184723660
Emotionally Disturbed Childrens' Residential Treatment Facility in Westminster, CO, US
NPI number: what is it?
The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...
| NPI | 1184723660 |
| NPI Entity Type | Organization |
| Provider Name | Devereux Cleo Wallace |
| Enumeration Date | September 30, 2009 |
| Last Update Date | September 30, 2009 |
| Certification Date | September 30, 2009 |
| Provider Location Address | 8405 Church Ranch Blvd, Westminster, CO, US |
| Provider Mailing Address | 8405 Church Ranch Blvd, Westminster, CO, US, 800213918 |
| Gender | Male |
| Is Sole Proprietor? | No |
Organization Official
| Official Name | Bonnie Wright |
| Official Position | QUALITY IMPROVEMENT DIRECTOR |
| Phone | 303-438-2265 |
Primary Taxonomy
| Taxonomy Code | |
| Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility |
| Classification |
Residential Treatment Facility, Emotionally Disturbed Children |
| Group | |
| License No. | 39794 |
| License State | CO |
| Description | A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. |
Secondary Taxonomies
| Taxonomy Code | Group | Classification | License No. | State | Primary? |
|---|---|---|---|---|---|
| 39794 | CO | No |
Other Identifiers
| Identifier | Identifier State | Identifier Issuer | Type/Code |
|---|---|---|---|
| 05350053 | CO | MEDICAID | 05 |
| 17284554 | CO | MEDICAID | 05 |
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