Provider Demographics
NPI:1679633192
Name:BLC - PARK PLACE, LLC
Entity Type:Organization
Organization Name:BLC - PARK PLACE, LLC
Other - Org Name:PARK PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-977-3700
Mailing Address - Street 1:601 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0593
Mailing Address - Country:US
Mailing Address - Phone:509-922-7224
Mailing Address - Fax:
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3586
Practice Address - Country:US
Practice Address - Phone:312-977-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH 1759310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA652398Medicaid