Healthcare Provider Details

I. General information

NPI: 1275695231
Provider Name (Legal Business Name): PAVILLON INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 PAVILLON PL
MILL SPRING NC
28756-5809
US

IV. Provider business mailing address

241 PAVILLON PL P.O. BOX 189
MILL SPRING NC
28756-5809
US

V. Phone/Fax

Practice location:
  • Phone: 828-625-8210
  • Fax: 866-700-1216
Mailing address:
  • Phone: 828-625-8210
  • Fax: 866-700-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-075-005
License Number StateNC

VIII. Authorized Official

Name: ANNE VANCE
Title or Position: CEO
Credential:
Phone: 828-625-8210