Provider Demographics
NPI:1396034237
Name:PARK PLACE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:PARK PLACE SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LACHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENKLE WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:HFA, MBA
Authorized Official - Phone:317-258-7031
Mailing Address - Street 1:4411 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8793
Mailing Address - Country:US
Mailing Address - Phone:260-480-2500
Mailing Address - Fax:
Practice Address - Street 1:4411 PARK PLACE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8793
Practice Address - Country:US
Practice Address - Phone:260-480-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility