Basic Information
| Provider Information | |||||||||
| NPI: | 1164446845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKSIDE FACILITY OPERATIONS, LLC | ||||||||
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| OtherOrganizationName: | PARKSIDE CARE ASSISTED LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CONCOURSE PKWY S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327516148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075711550 | ||||||||
| FaxNumber: | 4075711599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 OAK HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434201000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193344914 | ||||||||
| FaxNumber: | 4193320121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CONTE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4075711550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.