Organization
SHADY REST CARE PAVILION, INC.
Active
Parent organization
SHADY REST CARE PAVILION, INC.
Other names
Page Rehabilitation and Healthcare Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHADY REST CARE PAVILION, INC.
Authorized official
MR. WESTON R EDWARDS (CEO)
(239) 931-8402
Entity
Organization
Contact information
Practice address
2310 N AIRPORT RD, FORT MYERS, FL 33907-1426
(239) 931-8401
(239) 931-8453
Mailing address
2310 N AIRPORT RD, FORT MYERS, FL 33907-1426
(239) 931-8401
(239) 931-8453
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1497096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021390000
—
FL
Enumeration date
10/05/2005
Last updated
09/01/2016
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