Provider Demographics
NPI:1265049175
Name:DEVONSHIRE AL OPERATIONS, LLC
Entity type:Organization
Organization Name:DEVONSHIRE AL OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSCLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-760-5290
Mailing Address - Street 1:5 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 BEXLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-4504
Practice Address - Country:US
Practice Address - Phone:304-760-5290
Practice Address - Fax:681-235-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility