Provider Demographics
NPI:1801520622
Name:PARKLAND RESIDENTIAL CARE
Entity type:Organization
Organization Name:PARKLAND RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAYISENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-232-0419
Mailing Address - Street 1:3124 BERRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-3376
Mailing Address - Country:US
Mailing Address - Phone:607-232-0419
Mailing Address - Fax:
Practice Address - Street 1:3124 BERRY CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-3376
Practice Address - Country:US
Practice Address - Phone:607-232-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities