Provider Demographics
NPI:1720368095
Name:DEVCORE ADULT CARE, LLC
Entity Type:Organization
Organization Name:DEVCORE ADULT CARE, LLC
Other - Org Name:PIEDMONT VILLAGE OF YADKINVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-677-1315
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0759
Mailing Address - Country:US
Mailing Address - Phone:336-677-1315
Mailing Address - Fax:336-677-1296
Practice Address - Street 1:409 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8248
Practice Address - Country:US
Practice Address - Phone:336-677-1315
Practice Address - Fax:336-677-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-099-014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility