Healthcare Provider Details

I. General information

NPI: 1407444359
Provider Name (Legal Business Name): PARK CENTER NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 SOUTH AVE
YOUNGSTOWN OH
44512-2459
US

IV. Provider business mailing address

5665 SOUTH AVE
YOUNGSTOWN OH
44512-2459
US

V. Phone/Fax

Practice location:
  • Phone: 330-782-1173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CHARLES
Title or Position: MEMBER
Credential:
Phone: 330-782-1173