Provider Demographics
NPI:1861718629
Name:MSAB PARK CREEK CENTER, LLC
Entity type:Organization
Organization Name:MSAB PARK CREEK CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-842-5100
Mailing Address - Street 1:10064 N CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4066
Mailing Address - Country:US
Mailing Address - Phone:440-842-5100
Mailing Address - Fax:440-842-5147
Practice Address - Street 1:10064 N CHURCH DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4066
Practice Address - Country:US
Practice Address - Phone:440-842-5100
Practice Address - Fax:440-842-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2021R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility