Healthcare Provider Details

I. General information

NPI: 1316858889
Provider Name (Legal Business Name): PAVILION HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 SILVERLEAF TRL
BETHLEHEM GA
30620-1875
US

IV. Provider business mailing address

590 SILVERLEAF TRL
BETHLEHEM GA
30620-1875
US

V. Phone/Fax

Practice location:
  • Phone: 470-445-6838
  • Fax:
Mailing address:
  • Phone: 470-445-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SOLOMON OLUGBADE MOYOSOLA
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 470-865-1072