Provider Demographics
NPI:1578726733
Name:EAST PARK CARE CENTER
Entity Type:Organization
Organization Name:EAST PARK CARE CENTER
Other - Org Name:EAST PARK CARE - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-250-4080
Mailing Address - Street 1:8 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3800
Mailing Address - Country:US
Mailing Address - Phone:216-267-7229
Mailing Address - Fax:
Practice Address - Street 1:8 E PARK CIR
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3800
Practice Address - Country:US
Practice Address - Phone:216-267-7229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J&R ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0339113291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory