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General NPI Number Information
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NPI Number | 1942340229
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Entity Type | Organization
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Legal Business Name | J. PARK & SON, INC.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1620 WAYNE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-1548
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Country | US
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Telephone | 731-925-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 WAYNE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-1548
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Country | US
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Telephone | 731-925-4004
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JO PARK
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Credential |
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Telephone | 731-925-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0000000120
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License Number State | TN
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