Provider Demographics
NPI:1629116702
Name:PARKSIDE CARE CORPORATION II
Entity Type:Organization
Organization Name:PARKSIDE CARE CORPORATION II
Other - Org Name:CARE CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIDEQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-286-2273
Mailing Address - Street 1:1001 EASTWIND DR STE 401
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3318
Mailing Address - Country:US
Mailing Address - Phone:614-715-2188
Mailing Address - Fax:614-715-2198
Practice Address - Street 1:1001 EASTWIND DR STE 401
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3318
Practice Address - Country:US
Practice Address - Phone:614-715-2188
Practice Address - Fax:614-715-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2023401Medicaid
OHOH01421OtherOASIS ID
OH367723Medicare Oscar/Certification