=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255385274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CC-AVENTURA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2006
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19333 W COUNTRY CLUB DR
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-692-4700
-----------------------------------------------------
Fax | 305-692-4706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 S WACKER DR STE 8400
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60606-6316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-803-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSEL
-----------------------------------------------------
Name | TOMEK J KOSZYLKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-803-8443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------