Basic Information
| Provider Information | |||||||||
| NPI: | 1851874002 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVENTURA AT CREEKSIDE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1072 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087012650 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 N SCOTT ST | ||||||||
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| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184071833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702821099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2018 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | KASZIRER | ||||||||
| AuthorizedOfficialFirstName: | MOISHE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7188377700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.