Healthcare Provider Details

I. General information

NPI: 1508686429
Provider Name (Legal Business Name): PAVILION AT STOW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ENGLEWOOD DR
STOW OH
44224-3204
US

IV. Provider business mailing address

1 VALLEY GREENS DR
VALLEY STREAM NY
11581-3634
US

V. Phone/Fax

Practice location:
  • Phone: 330-688-1828
  • Fax:
Mailing address:
  • Phone: 516-865-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KYMBERLY LAVIN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 516-865-1500