Provider Demographics
NPI:1245580182
Name:PAVILION HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:PAVILION HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:EJIZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-753-1201
Mailing Address - Street 1:17420 AVALON BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17420 AVALON BLVD
Practice Address - Street 2:STE 206
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1564
Practice Address - Country:US
Practice Address - Phone:310-753-1201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health