Provider Demographics
NPI:1891093787
Name:DEVINE SENIOR CARE, INC.
Entity Type:Organization
Organization Name:DEVINE SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCFARLANE
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:772-465-9389
Mailing Address - Street 1:4707 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:FT. PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-467-0668
Mailing Address - Fax:
Practice Address - Street 1:4707 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:FT. PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982
Practice Address - Country:US
Practice Address - Phone:772-467-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5658310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility