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:
Map and Directions
Authorized official contact:
Name: Wagner, Fran
Phone: (610) 542-3084

Health care specialties

SpecialtyCodeLicense #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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1306960091 NPPES
New Jersey MEDICAID 0010537

Popular Providers