Provider Demographics
NPI:1417686429
Name:WINDSTAR RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:WINDSTAR RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DEVILME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-868-3757
Mailing Address - Street 1:1815 GRAND CAYMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5450
Mailing Address - Country:US
Mailing Address - Phone:214-868-3757
Mailing Address - Fax:972-222-9815
Practice Address - Street 1:1815 GRAND CAYMAN WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5450
Practice Address - Country:US
Practice Address - Phone:214-868-3757
Practice Address - Fax:972-222-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility