MEDICARE: AVENTURA AT CARRIAGE INN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1871256487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENTURA AT CARRIAGE INN LLC

Provider Business Mailing Address
First Line	:	1105 E COUNTY LINE RD STE 206
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2122
Country	:	US
Telephone Number	:	610-686-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3604
Country	:	US
Telephone Number	:	937-278-0404
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MARK KASZIRER
Credential	:
Telephone Number	:	610-686-3300

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/31/2023

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