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General NPI Number Information
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NPI Number | 1720368095
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Entity Type | Organization
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Legal Business Name | DEVCORE ADULT CARE, LLC
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 409 HARRISON AVE
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City | YADKINVILLE
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State | NC
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Zip | 27055-8248
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Country | US
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Telephone | 336-677-1315
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Fax | 336-677-1296
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Provider Business Mailing Address
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Address Line | PO BOX 759
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City | YADKINVILLE
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State | NC
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Zip | 27055-0759
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Country | US
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Telephone | 336-677-1315
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Fax | 336-677-1296
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE SPARKS
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Credential |
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Telephone | 336-677-1315
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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 | HAL-099-014
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License Number State | NC
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