Organization
PED-E-CARE
Active
Organization
PED-E-CARE
Active
Other names
PARC Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE T PARK RN (DIRECTOR OF NURSING)
(904) 608-4688
Entity
Organization
Contact information
Practice address
540 STATE ROAD 13, SUITE 104, FRUIT COVE, FL 32259-3872
(904) 814-8209
Mailing address
540 STATE ROAD 13, SUITE 104, FRUIT COVE, FL 32259-3872
(904) 814-8209
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
60080992
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60080992
PPEC LICENSE NUMBER
FL
Enumeration date
09/03/2010
Last updated
09/03/2010
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