Organization
PARC INC
Active
Other names
PARC Cottages
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WAYNE CAVANAUGH (OWNER)
(727) 345-9111
Entity
Organization
Contact information
Practice address
3190 75TH ST N, ST PETERSBURG, FL 33710-2326
(727) 345-9111
(727) 345-7130
Mailing address
3190 75TH ST N, ST PETERSBURG, FL 33710-2326
(727) 345-9111
(727) 345-7130
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
4054095
FL
315P00000X
Intellectual Disabilities Intermediate Care Facility
4055095
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028035600
—
FL
05
—
028505600
—
FL
Enumeration date
02/28/2007
Last updated
11/24/2021
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