Provider Demographics
NPI:1396012423
Name:ROSS, DONETTE LAVELL (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:DONETTE
Middle Name:LAVELL
Last Name:ROSS
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 LEDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-4320
Mailing Address - Country:US
Mailing Address - Phone:469-258-9142
Mailing Address - Fax:972-692-5759
Practice Address - Street 1:14860 LEDGEVIEW CT
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-4320
Practice Address - Country:US
Practice Address - Phone:469-258-9142
Practice Address - Fax:972-692-5759
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility