Organization
DEVONSHIRE RETIREMENT VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN PETERSON (ADMINISTRATOR)
(810) 245-7646
Entity
Organization
Contact information
Practice address
101 DEVONSHIRE DR, LAPEER, MI 48446-2855
(810) 245-7646
Mailing address
3196 KRAFT AVE SE, SUITE 200, GRAND RAPIDS, MI 49512-2078
(616) 464-1564
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL440257936
MI
310400000X
Assisted Living Facility
AL440263405
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1102013
CLIA
MI
Enumeration date
11/16/2009
Last updated
11/16/2009
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