Provider Demographics
NPI:1013696020
Name:PAVILLON OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:PAVILLON OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-694-2300
Mailing Address - Street 1:115 PAVILLON PLACE
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 PAVILLON PLACE
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756
Practice Address - Country:US
Practice Address - Phone:828-694-2300
Practice Address - Fax:866-990-3066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAVILLON INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265512834OtherMEDICAL DIRECTOR