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General NPI Number Information
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NPI Number | 1508686429
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Entity Type | Organization
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Legal Business Name | PAVILION AT STOW, LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 3700 ENGLEWOOD DR
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City | STOW
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State | OH
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Zip | 44224-3204
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Country | US
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Telephone | 330-688-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 1 VALLEY GREENS DR
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3634
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Country | US
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Telephone | 516-865-1500
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | KYMBERLY LAVIN
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Credential |
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Telephone | 516-865-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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