Provider Demographics
NPI:1023345139
Name:PAVILLON GREENVILLE OUTPATIENT SERVICES
Entity type:Organization
Organization Name:PAVILLON GREENVILLE OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-694-2337
Mailing Address - Street 1:103 PELHAM COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4974
Mailing Address - Country:US
Mailing Address - Phone:864-241-6688
Mailing Address - Fax:866-990-3066
Practice Address - Street 1:103 PELHAM COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4974
Practice Address - Country:US
Practice Address - Phone:864-241-6688
Practice Address - Fax:866-990-3066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAVILLON INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOTP-0102261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder