Provider Demographics
NPI:1699786061
Name:HEALTHPARK CARE CENTER, INC.
Entity type:Organization
Organization Name:HEALTHPARK CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-343-7300
Mailing Address - Street 1:16131 ROSERUSH CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3634
Mailing Address - Country:US
Mailing Address - Phone:239-433-4647
Mailing Address - Fax:239-432-3456
Practice Address - Street 1:16131 ROSERUSH CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3634
Practice Address - Country:US
Practice Address - Phone:239-433-4647
Practice Address - Fax:239-432-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1202096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021058700Medicaid
FL021058700Medicaid