Provider Demographics
NPI:1740763895
Name:AVENTURA AT PEMBROOKE, LLC
Entity Type:Organization
Organization Name:AVENTURA AT PEMBROOKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOISHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASZIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-837-7700
Mailing Address - Street 1:1072 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5005
Practice Address - Country:US
Practice Address - Phone:610-692-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility