Provider Demographics
NPI:1326027723
Name:HOLLYWOOD PAVILION LLC
Entity Type:Organization
Organization Name:HOLLYWOOD PAVILION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLEN-ZURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-962-1355
Mailing Address - Street 1:1201 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5414
Mailing Address - Country:US
Mailing Address - Phone:954-962-1355
Mailing Address - Fax:954-981-5520
Practice Address - Street 1:1201 N 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5414
Practice Address - Country:US
Practice Address - Phone:954-962-1355
Practice Address - Fax:954-981-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4361283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE80OtherBLUE CROSS PROVIDER NUMBE
FL104015Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER