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Organization
DEVINE CONVALESCENT CARE CENTER INC
Active
Organization
DEVINE CONVALESCENT CARE CENTER INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
104 ENTERPRISE AVE, DEVINE, TX 78016-1807
(830) 663-4451
Mailing address
104 ENTERPRISE AVE, DEVINE, TX 78016-1807
(830) 663-4451
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
112767
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001012206
—
TX
01
—
1767741-01
TEXAS MEDICAID B
TX
01
—
HH027S
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
09/27/2005
Last updated
08/28/2008
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