Park Trail Placellc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

12040 Issued in FL

Legal business name

PARK TRAIL PLACELLC

Practice address

302 N Park Ave
Apopka, FL 32703-4150

Phone

(407) 814-2273

Fax

(404) 464-7006

NPI assigned

Oct 15, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Cherise Roach

Title

Owner

Phone

(407) 814-2273

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dream Lake Doing business as

Locations

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

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1679901466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N PARK AVE",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327034150",
            "telephone_number": "407-814-2273",
            "fax_number": "404-464-7006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 N PARK AVE",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327034150",
            "telephone_number": "407-814-2273",
            "fax_number": "404-464-7006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK TRAIL PLACELLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "CHERISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-814-2273",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004341200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dream Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Parmatma Parajuli, MD
• Debora A Pareja-Neyra, MD
• Trisha M Parisi, AP
• Park Ave Medical Group
• Park Avenue Ophthalmics, PLLC
• Zarette Mechelle Parker, RNF
• Anjali K Parti, OTD, OTR/L
• Cristina Pascal Ricart, MD
• Julio Pasos
• Passionate Hands of Care

• Assisted Living Facility in Apopka, FL
• Providers in Apopka, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.