Provider Demographics
NPI:1437461241
Name:DEVONSHIRE RETIREMENT VILLAGE, LLC
Entity Type:Organization
Organization Name:DEVONSHIRE RETIREMENT VILLAGE, LLC
Other - Org Name:DEVONSHIRE RETIREMENT VILLAGE - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-245-7646
Mailing Address - Street 1:101 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2855
Mailing Address - Country:US
Mailing Address - Phone:810-245-7646
Mailing Address - Fax:
Practice Address - Street 1:101 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2855
Practice Address - Country:US
Practice Address - Phone:810-245-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D1102013291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory