Provider Demographics
NPI:1568462471
Name:DEVON GABLES HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:DEVON GABLES HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-296-6181
Mailing Address - Street 1:6150 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5801
Mailing Address - Country:US
Mailing Address - Phone:520-296-6181
Mailing Address - Fax:520-298-0997
Practice Address - Street 1:6150 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5801
Practice Address - Country:US
Practice Address - Phone:520-296-6181
Practice Address - Fax:520-298-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3006445-1616B314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ131714Medicaid
AZ035145Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER