Provider Demographics
NPI:1467807057
Name:ADULT CARE CENTER OF THE NSV
Entity Type:Organization
Organization Name:ADULT CARE CENTER OF THE NSV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLINN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOLITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-722-2273
Mailing Address - Street 1:411 N CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6046
Mailing Address - Country:US
Mailing Address - Phone:540-722-2273
Mailing Address - Fax:540-450-2263
Practice Address - Street 1:411 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6046
Practice Address - Country:US
Practice Address - Phone:540-722-2273
Practice Address - Fax:540-450-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
VA385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087303852Medicaid