=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356259386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK AVENUE REHABILITATION & HEALTHCARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14714 PARK AVENUE EXT
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16335-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-337-4228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 ROUTE 70
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08755-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICARE AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | AARON SZYDLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-555-0101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------