Provider Demographics
NPI:1437545274
Name:INVICTA PARK PLACE LLC
Entity Type:Organization
Organization Name:INVICTA PARK PLACE LLC
Other - Org Name:PARK PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMONICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-418-2567
Mailing Address - Street 1:541 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7016
Mailing Address - Country:US
Mailing Address - Phone:727-418-2567
Mailing Address - Fax:
Practice Address - Street 1:541 PARK ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7016
Practice Address - Country:US
Practice Address - Phone:727-418-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8284310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility