ANDOVER SNF OPCO LLC
NPI 1063348167
Skilled Nursing Facility in Andover, OH

Active since June 18, 2026CLIA 36D0678845 · Waiver
486 S MAIN ST, ANDOVER, OH 44003(440) 293-5416 Get Directions Write a Review

NPPES record last updated: June 19, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Andover Snf Opco Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDOVER SNF OPCO LLC (NPI 1063348167), doing business as Andover Village Rehabilitation And Wellness, is a healthcare organization registered as a skilled nursing facility in Andover, Ohio and active in the NPI registry since June 2026. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Yechezkel Serebrowski, Coo Of The Opco, as its authorized official.

NPPES Registry Identity

NPI1063348167
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameANDOVER SNF OPCO LLC
Location Address486 S MAIN STAndover, OH 44003-9602
Mailing Address6950 Us Highway 9 Ste 107Howell, NJ 07731-3322
Organization SubpartNo
Authorized OfficialYechezkel SerebrowskiCoo Of The Opco · (845) 422-3916
Enumeration DateJune 18, 2026
Last NPPES UpdateJune 19, 2026
NPPES CertifiedJune 19, 2026
NPI 1063348167 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
486 S MAIN ST, Andover, OH 44003

Other Names 1

Doing Business AsAndover Village Rehabilitation And Wellness

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D0678845

Andover Village Retirement Comm Ltd · Andover, OH
Active · expires Aug 31, 2026
CLIA Number36D0678845
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorSara Gantz
Laboratory Phone(440) 293-5416
Laboratory LocationAndover Village Retirement Comm Ltd486 S Main Street, Andover, OH 44003
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
486 S MAIN ST
ANDOVER, OH 44003

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andover Snf Opco LLC's NPI number?

The NPI number for Andover Snf Opco LLC is 1063348167. It was assigned to this organization in the NPPES registry on June 18, 2026. The provider is doing business as Andover Village Rehabilitation and Wellness.

Where is Andover Snf Opco LLC located?

Andover Snf Opco LLC is located at 486 S Main St, Andover, OH 44003. The listed phone number is (440) 293-5416.

What is Andover Snf Opco LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Andover Snf Opco LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D0678845) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Andover Snf Opco LLC was last updated on June 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 45 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.