Shady Rest Care Pavilion, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1497096 Issued in FL

Legal business name

SHADY REST CARE PAVILION, INC.

Doing business as

Page Rehabilitation and Healthcare Center

Practice address

2310 N Airport Rd
Fort Myers, FL 33907-1426

Phone

(239) 931-8401

Fax

(239) 931-8453

NPI assigned

Oct 5, 2005

Organization subpart

Yes

Parent organization

SHADY REST CARE PAVILION, INC.As reported in NPPES

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

Authorized official

Name

Mr. Weston R Edwards

Title

Ceo

Phone

(239) 931-8402

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Page Rehabilitation and Healthcare Center Doing business as

Part of

Shady Rest Care Pavilion Inc

Locations

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1881681724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 N AIRPORT RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071426",
            "telephone_number": "239-931-8401",
            "fax_number": "239-931-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 N AIRPORT RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071426",
            "telephone_number": "239-931-8401",
            "fax_number": "239-931-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY REST CARE PAVILION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHADY REST CARE PAVILION, INC.",
        "enumeration_date": "2005-10-05",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "WESTON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-931-8402",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1497096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021390000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Page Rehabilitation and Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel L Seyss, CRNA
• SF Medical Needs LLC
• SFWC Medical Inc (southwest florida wellness center)
• Alicia Sgroi, PA-C
• Jan Rosalyn Shabot, LCSW
• Amber Dawn Shaffer, DNP
• Nicolette Shaffer, OTR
• Bhavan Upendrakumar Shah, M.D.
• Bipin Shah, M.D.
• Jay Chetan Shah, DMD

• Skilled Nursing Facility in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.