Basic Information
| Provider Information | |||||||||
| NPI: | 1467117713 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARK PLACE SENIOR CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23648 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767023648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547415929 | ||||||||
| FaxNumber: | 2547415928 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 E 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | BELTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765132298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547415929 | ||||||||
| FaxNumber: | 2547415928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2021 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2547415929 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.