MEDICARE: DEVINE SENIOR CARE, INC.

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	5658	FL

General Provider Information

NPI Number	:	1891093787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE SENIOR CARE, INC.

Provider Business Mailing Address
First Line	:	4707 OLEANDER AVE
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-467-0668
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 OLEANDER AVE
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-467-0668
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MAVIS A MCFARLANE
Credential	:	ADM
Telephone Number	:	772-465-9389

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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