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General NPI Number Information
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NPI Number | 1699786061
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Entity Type | Organization
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Legal Business Name | HEALTHPARK CARE CENTER, INC.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 16131 ROSERUSH CT
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City | FORT MYERS
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State | FL
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Zip | 33908-3634
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Country | US
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Telephone | 239-433-4647
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Fax | 239-432-3456
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Provider Business Mailing Address
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Address Line | 16131 ROSERUSH CT
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City | FORT MYERS
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State | FL
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Zip | 33908-3634
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Country | US
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Telephone | 239-433-4647
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Fax | 239-432-3456
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TROY CHURCHILL
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Credential |
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Telephone | 239-343-7300
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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 | SNF1202096
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License Number State | FL
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