Provider Demographics
NPI:1891786604
Name:THE BALL PAVILION
Entity Type:Organization
Organization Name:THE BALL PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BVFI
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-899-8600
Mailing Address - Street 1:5416 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1427
Mailing Address - Country:US
Mailing Address - Phone:814-899-8600
Mailing Address - Fax:814-898-1910
Practice Address - Street 1:5416 E LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1427
Practice Address - Country:US
Practice Address - Phone:814-899-8600
Practice Address - Fax:814-898-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA540302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007479270001Medicaid
PA0007479270001Medicaid