Healthcare Provider Details

I. General information

NPI: 1851874002
Provider Name (Legal Business Name): AVENTURA AT CREEKSIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N SCOTT ST
CARBONDALE PA
18407-1833
US

IV. Provider business mailing address

1072 MADISON AVE
LAKEWOOD NJ
08701-2650
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-1099
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. MOISHE KASZIRER
Title or Position: MEMBER
Credential:
Phone: 718-837-7700