Provider Demographics
NPI:1184085045
Name:PAVILION MEDICAL HOME CARE & STAFFING LLC
Entity type:Organization
Organization Name:PAVILION MEDICAL HOME CARE & STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIBSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERHUNMWUNSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-346-7488
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE #211A
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:240-346-7488
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE #211A
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:240-346-7488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health