Provider Demographics
NPI:1285941971
Name:DEVONSHIRE MANOR INC.
Entity type:Organization
Organization Name:DEVONSHIRE MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-220-4516
Mailing Address - Street 1:891 DEVONSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:891 DEVONSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1705
Practice Address - Country:US
Practice Address - Phone:810-220-4516
Practice Address - Fax:810-225-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS470291101385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care