Provider Demographics
NPI:1871256487
Name:AVENTURA AT CARRIAGE INN LLC
Entity Type:Organization
Organization Name:AVENTURA AT CARRIAGE INN LLC
Other - Org Name:AVENTURA AT CARRIAGE INN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KASZIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-686-3300
Mailing Address - Street 1:1105 E COUNTY LINE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2122
Mailing Address - Country:US
Mailing Address - Phone:610-686-3300
Mailing Address - Fax:
Practice Address - Street 1:5040 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3604
Practice Address - Country:US
Practice Address - Phone:937-278-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility