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General NPI Number Information
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NPI Number | 1336228881
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Entity Type | Organization
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Legal Business Name | PARK SUPERIOR HEALTHCARE,LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1445 SUPERIOR AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2707
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Country | US
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Telephone | 949-642-2410
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Fax | 949-642-6386
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Provider Business Mailing Address
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Address Line | 1445 SUPERIOR AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2707
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Country | US
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Telephone | 949-642-2410
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Fax | 949-642-6386
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DIANA L. SCHILLING
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Credential |
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Telephone | 949-642-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | CA
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