NPIMap

Organization Active NPI

Parc Inc

  • Intellectual Disabilities Intermediate Care Facility
  • St Petersburg, FL
National Provider Identifier
1477680916
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
4054095 Issued in FL
Legal business name
PARC INC
Practice address
3190 75TH St N
St Petersburg, FL 33710-2326
Phone
(727) 345-9111
Fax
(727) 345-7130
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Wayne Cavanaugh
Title
Owner
Phone
(727) 345-9111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 4054095 FL Primary
Intellectual Disabilities Intermediate Care Facility 315P00000X 4055095 FL

Addresses

Primary practice location

3190 75TH St N
St Petersburg, FL 33710-2326

Mailing address

3190 75TH St N
St Petersburg, FL 33710-2326
Phone (727) 345-9111

Other identifiers 2

IdentifierTypeStateIssuer
028035600MedicaidFL
028505600MedicaidFL

Other names 1

  • PARC Cottages Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 10G018

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PARC INC
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 1, 1979
Last certification
Mar 27, 2024
Beds
48
Ownership / control type
Private (non-profit)
Facility address
3190 75TH St N
Saint Petersburg, FL 33710

National Provider Directory

National Provider Directory
Tax ID family
Parc Cottages2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • Parc Inc
    • Intellectual Disabilities Intermediate Care Facility
    • St Petersburg, FL
    • NPI 1285399667
    NPD tax ID

Locations

3190 Tyrone Blvd N
St Petersburg, FL 33710
Phone (727) 345-9111

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637712000000",
    "number": "1477680916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 75TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337102326",
            "telephone_number": "727-345-9111",
            "fax_number": "727-345-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 75TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337102326",
            "telephone_number": "727-345-9111",
            "fax_number": "727-345-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-345-9111"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "FL",
            "license": "4054095",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "FL",
            "license": "4055095",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028035600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028505600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARC Cottages",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.