Kanner Jackson Villa
LBN: Devereux Kanner
Kanner Jackson Villa is an health care organization with primary practice located at 390 E Boot Rd 101 Genuardi Circle, West Chester PA 19380-1222. The organization recently has 2 registered licenses in different health care specialties including Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children. Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children is the primary health care specialty.
Devereux Kanner can be contacted via phone (610) 431-8100, or through Wagner, Fran via phone (610) 542-3084.
Contact Information
Primary practice address
390 E Boot Rd 101 Genuardi Circle
West Chester PA 19380-1222
Phone: (610) 431-8100
Fax: (610) 431-3155
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness | 320800000X | 112050 | Pennsylvania |
| Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 132880 | Pennsylvania |
Profile Details
| NPI number | 1306960091 |
|---|---|
| LBN Legal business name | Devereux Kanner |
| DBA Doing business as | Kanner Jackson Villa |
| Authorized official | Wagner, Fran |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 19th, 2007 |
| Last updated | Aug 31st, 2010 - about 14 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306960091 | NPPES |
| New Jersey | MEDICAID | 0010537 |
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