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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