Healthcare Provider Details

I. General information

NPI: 1639612120
Provider Name (Legal Business Name): PARK AVENUE REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 PARK AVENUE EXT
MEADVILLE PA
16335-9400
US

IV. Provider business mailing address

245 BIRCHWOOD AVE
CRANFORD NJ
07016-2510
US

V. Phone/Fax

Practice location:
  • Phone: 814-337-4228
  • 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: TERRI SHERMAN
Title or Position: COO
Credential:
Phone: 908-315-3400