Provider Demographics
NPI:1043412430
Name:PAVILION GARDENS LLC
Entity Type:Organization
Organization Name:PAVILION GARDENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GODINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-884-5613
Mailing Address - Street 1:71 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5412
Mailing Address - Country:US
Mailing Address - Phone:305-884-5613
Mailing Address - Fax:305-884-5225
Practice Address - Street 1:71 W 30TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5412
Practice Address - Country:US
Practice Address - Phone:305-884-5613
Practice Address - Fax:305-884-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74693104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness