Provider Demographics
NPI:1871708396
Name:PARK'S HEALTH CARE GROUP, LTD.
Entity type:Organization
Organization Name:PARK'S HEALTH CARE GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:L AC DOM
Authorized Official - Phone:253-815-9191
Mailing Address - Street 1:33100 PACIFIC HWY. S., STE1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6445
Mailing Address - Country:US
Mailing Address - Phone:253-815-9191
Mailing Address - Fax:425-778-3377
Practice Address - Street 1:33100 PACIFIC HWY. S., STE1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6445
Practice Address - Country:US
Practice Address - Phone:253-815-9191
Practice Address - Fax:425-778-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC376305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization