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General NPI Number Information
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NPI Number | 1285399667
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Entity Type | Organization
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Legal Business Name | PARC INC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 3101 76TH WAY N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-2302
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Country | US
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Telephone | 727-345-9111
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Fax | 727-345-7130
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Provider Business Mailing Address
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Address Line | 3190 75TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-2326
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Country | US
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Telephone | 727-345-9111
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Fax | 727-345-7130
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK WAYNE CAVANAUGH
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Credential |
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Telephone | 727-345-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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