Provider Demographics
NPI:1871263194
Name:DEVOTED CARE ASSISTED LIVING SERVICES LLC
Entity type:Organization
Organization Name:DEVOTED CARE ASSISTED LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINCEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:513-400-1855
Mailing Address - Street 1:10979 REED HARTMAN HWY
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2800
Mailing Address - Country:US
Mailing Address - Phone:513-400-1855
Mailing Address - Fax:
Practice Address - Street 1:10979 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2800
Practice Address - Country:US
Practice Address - Phone:513-400-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0451477Medicaid