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General NPI Number Information
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NPI Number | 1073763074
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Entity Type | Organization
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Legal Business Name | DEVINDALE INC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 6 ZODIACAL PL
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City | PALM COAST
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State | FL
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Zip | 32164-5811
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Country | US
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Telephone | 386-313-3359
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Fax | 386-437-9973
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Provider Business Mailing Address
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Address Line | 6 ZODIACAL PL
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City | PALM COAST
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State | FL
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Zip | 32164-5811
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Country | US
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Telephone | 386-313-3359
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Fax | 386-437-9973
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JACQUELINE ELAINE BUCK
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Credential | REGISTERED NURSE
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Telephone | 386-313-3359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11247
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License Number State | FL
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