Provider Demographics
NPI:1972357929
Name:DEVANK LLC
Entity Type:Organization
Organization Name:DEVANK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVADATT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MISHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-508-9634
Mailing Address - Street 1:3728 E WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2112
Mailing Address - Country:US
Mailing Address - Phone:562-508-9634
Mailing Address - Fax:
Practice Address - Street 1:2157 W LA PALMA AVENUE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:562-508-9634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:202206111274
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility