MEDICARE: DEVONSHIRE RETIREMENT VILLAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL440263405	MI
2	310400000X	Assisted Living Facility	AL440257936	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23D1102013	OTHER	MI	CLIA

General Provider Information

NPI Number	:	1841527660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVONSHIRE RETIREMENT VILLAGE

Provider Business Mailing Address
First Line	:	3196 KRAFT AVE SE
Second Line	:	SUITE 200
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-2078
Country	:	US
Telephone Number	:	616-464-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 DEVONSHIRE DR
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2855
Country	:	US
Telephone Number	:	810-245-7646
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. SUSAN PETERSON
Credential	:
Telephone Number	:	810-245-7646

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	11/16/2009

Similar Medicare Providers

1124980875 — WENDY BUIKE
Practice Location Address:

101 DEVONSHIRE DR
LAPEER, MI
48446-2855

Practice Phone: 810-356-9238
Practice Fax:

1437461241 — DEVONSHIRE RETIREMENT VILLAGE, LLC
Practice Location Address:

101 DEVONSHIRE DR
LAPEER, MI
48446-2855

Practice Phone: 810-245-7646
Practice Fax:

1316827074 — CLARA ASH
Practice Location Address:

101 DEVONSHIRE DR
LAPEER, MI
48446-2855

Practice Phone: 810-245-7646
Practice Fax:

1316054810 — RESIDENTIAL HOME HEALTH AND HOSPICE, INC.
Practice Location Address:

1681 WOODBRIDGE PARK AVE.
LAPEER, MI
48446-4422

Practice Phone: 810-245-3300
Practice Fax: 810-245-3665

1811464787 — AMY VERHOEVEN MS, LLPC
Practice Location Address:

624 W NEPESSING ST
LAPEER, MI
48446-2090

Practice Phone: 989-672-6160
Practice Fax:

1073541280 — DR. ALLAN KEITH THORBURN MD
Practice Location Address:

1570 SUNCREST DR
LAPEER, MI
48446-1154

Practice Phone: 810-667-0500
Practice Fax: 810-664-8728

Directions to “DEVONSHIRE RETIREMENT VILLAGE ” Practice Location

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