Provider Demographics
NPI:1184864126
Name:PARK CREEK CENTER
Entity Type:Organization
Organization Name:PARK CREEK CENTER
Other - Org Name:SPC SENIOR MANAGEMENT, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-842-5100
Mailing Address - Street 1:10064 N CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4066
Mailing Address - Country:US
Mailing Address - Phone:440-842-5100
Mailing Address - Fax:440-842-5147
Practice Address - Street 1:10064 N CHURCH DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4066
Practice Address - Country:US
Practice Address - Phone:440-842-5100
Practice Address - Fax:440-842-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2021R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2781468Medicaid