Provider Demographics
NPI:1790163376
Name:THE PAVILION AT VESTAL, LLC
Entity Type:Organization
Organization Name:THE PAVILION AT VESTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-371-8100
Mailing Address - Street 1:1 HILLCREST CTR
Mailing Address - Street 2:SUITE #325
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3740
Mailing Address - Country:US
Mailing Address - Phone:845-371-8100
Mailing Address - Fax:845-371-0010
Practice Address - Street 1:105 WEST SHEEDY ROAD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1753
Practice Address - Country:US
Practice Address - Phone:845-371-8100
Practice Address - Fax:845-371-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTO BE DETERMINED310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility