Andover SNF Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ANDOVER SNF OPCO LLC

Doing business as

Andover Village Rehabilitation and Wellness

Practice address

486 S Main St
Andover, OH 44003-9602

Phone

(440) 293-5416

NPI assigned

Jun 18, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yechezkel Serebrowski

Title

Coo of the Opco

Phone

(845) 422-3916

Specialties & licenses 1

Addresses

Other names 1

• Andover Village Rehabilitation and Wellness Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1781740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781827200000",
    "number": "1063348167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 US HIGHWAY 9 STE 107",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077313322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 S MAIN ST",
            "city": "ANDOVER",
            "state": "OH",
            "postal_code": "440039602",
            "telephone_number": "440-293-5416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDOVER SNF OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-18",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A",
        "authorized_official_last_name": "SEREBROWSKI",
        "authorized_official_first_name": "YECHEZKEL",
        "authorized_official_title_or_position": "COO OF THE OPCO",
        "authorized_official_telephone_number": "845-422-3916"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Andover Village Rehabilitation and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 4M Emergency Systems Andover LLC
• Loan Thi Alexander
• Anchor of Hope Center
• Andover Village Retirement Community, LTD
• Angelo F. Petrolla
• Ankle and Foot Care Centers
• Tracy Beth Anthony, COTA/L
• John Baumeier, DO

• Skilled Nursing Facility in Andover, OH
• Providers in Andover, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.