MEDICARE: PARKE FAMILY SENIOR CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	2012-HHA-98614	UT

General Provider Information

NPI Number	:	1003155797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKE FAMILY SENIOR CARE INC.

Provider Business Mailing Address
First Line	:	8539 S REDWOOD RD
Second Line	:	SUITE B
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5250
Country	:	US
Telephone Number	:	801-542-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	8539 S REDWOOD RD
Second Line	:	SUITE B
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-5250
Country	:	US
Telephone Number	:	801-542-0405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID PARKE
Credential	:
Telephone Number	:	801-542-0405

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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