# DEVINE CONVALESCENT CARE CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Living Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689660417
- **Authorized official:** MR. JANICE PITA (INSURANCE/MEDICARE)
- **Authorized official phone:** (580) 622-6300

## Contact information

- **Practice address:** 104 ENTERPRISE AVE, DEVINE, TX 78016-1807
- **Practice address phone:** (830) 663-4451
- **Mailing address:** 104 ENTERPRISE AVE, DEVINE, TX 78016-1807
- **Mailing address phone:** (830) 663-4451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 112767 | TX | Yes |

## Other

- **Enumeration date:** 09/27/2005
- **Last updated:** 08/28/2008

## 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 |