NPI 1346319142

Devereux Foundation

Organisation Psychiatric Residential Treatment Facility Kennesaw, GA

Practice location

Address: 1291 Stanley Rd NW, Kennesaw, GA 30152-4359
Phone: (770) 427-0147
Mailing address: 1283 Kennestone Cir Suite 100, Marietta, GA 30066-6029

Authorised official

Name: Mario Bolivar
Title: Executive Director
Phone: (687) 303-2669

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X Licence 5910 (GA)

Other Psychiatric Residential Treatment Facility providers in Georgia →

Registry record

NPI: 1346319142
Entity type: Organization
NPI issued: 7 Nov 2006
Record last updated: 16 Jan 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.