Provider Demographics
NPI:1306404173
Name:PARK PLACE ADULT DAY SERVICES
Entity Type:Organization
Organization Name:PARK PLACE ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-422-2795
Mailing Address - Street 1:220 3RD AVE S STE 2
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-2773
Mailing Address - Country:US
Mailing Address - Phone:715-422-2795
Mailing Address - Fax:715-422-2782
Practice Address - Street 1:220 3RD AVE S STE 2
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2773
Practice Address - Country:US
Practice Address - Phone:715-422-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care