Provider Demographics
NPI:1073763074
Name:DEVINDALE INC
Entity Type:Organization
Organization Name:DEVINDALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:386-313-3359
Mailing Address - Street 1:6 ZODIACAL PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5811
Mailing Address - Country:US
Mailing Address - Phone:386-313-3359
Mailing Address - Fax:386-437-9973
Practice Address - Street 1:6 ZODIACAL PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5811
Practice Address - Country:US
Practice Address - Phone:386-313-3359
Practice Address - Fax:386-437-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11247310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility