Organization
PARK TRAIL PLACELLC
Active
Other names
Dream Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERISE ROACH (OWNER)
(407) 814-2273
Entity
Organization
Contact information
Practice address
302 N PARK AVE, APOPKA, FL 32703-4150
(407) 814-2273
(404) 464-7006
Mailing address
302 N PARK AVE, APOPKA, FL 32703-4150
(407) 814-2273
(404) 464-7006
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12040
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004341200
—
FL
Enumeration date
10/15/2013
Last updated
10/15/2013
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