Healthcare Provider Details

I. General information

NPI: 1104940287
Provider Name (Legal Business Name): PARK AVENUE NURSING & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PARK AVE
ARLINGTON MA
02476-5829
US

IV. Provider business mailing address

146 PARK AVE
ARLINGTON MA
02476-5829
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-9530
  • Fax: 781-646-3668
Mailing address:
  • Phone: 781-648-9530
  • Fax: 781-646-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0777
License Number StateMA

VIII. Authorized Official

Name: MR. JOHN ALESSANDRONI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 781-648-9530