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NPI Code Detail

MEDICARE: PARK AVENUE NURSING & REHABILITATION CENTER INC

MEDICARE: PARK AVENUE NURSING & REHABILITATION CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0777MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17100196OTHERMAEVERCARE PROVIDER #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3906183OTHERMAHARVARD PILGRIM PROVID #
4904423OTHERMATUFTS HEALTH PLAN PROV #
52222558401OTHERMABLUE CROSS PROVIDER #

General Provider Information

NPI Number : 1104940287
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK AVENUE NURSING & REHABILITATION CENTER INC
Provider Business Mailing Address
First Line : 146 PARK AVE
Second Line :
City : ARLINGTON
State : MA
Zip : 02476-5829
Country : US
Telephone Number : 781-648-9530
Fax Number : 781-646-3668
Provider Business Practice Location Address
First Line : 146 PARK AVE
Second Line :
City : ARLINGTON
State : MA
Zip : 02476-5829
Country : US
Telephone Number : 781-648-9530
Fax Number : 781-646-3668
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JOHN ALESSANDRONI
Credential :
Telephone Number : 781-648-9530
Provider Enumeration Date : 03/16/2007
Last Update Date : 09/14/2011

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Practice Location Address:
146 PARK AVE
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02476-5829
Practice Phone: 781-648-9530
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1326249046 — TRACEY ANN GIORGIO PTA
Practice Location Address:
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ARLINGTON, MA
02476-5829
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Practice Fax:
1801097555 — MS. ANASTASIA HAMIZIDES COTA
Practice Location Address:
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1770838807 — MR. KYLE STUART JERDAN BACHELOR
Practice Location Address:
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ARLINGTON, MA
02476-5829
Practice Phone: 607-279-7999
Practice Fax:

Directions to “PARK AVENUE NURSING & REHABILITATION CENTER INC ” Practice Location

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