NPIMap

Organization Active NPI

Pavillon Greenville Outpatient Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Greenville, SC
National Provider Identifier
1023345139
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
OTP-0102 Issued in SC
Legal business name
PAVILLON GREENVILLE OUTPATIENT SERVICES
Practice address
103 Pelham Commons Blvd
Greenville, SC 29615-4974
Phone
(864) 241-6688
Fax
(866) 990-3066
NPI assigned
Nov 10, 2009
Organization subpart
Yes
Parent organization
PAVILLON INTERNATIONALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cindy Keator
Title
Billing
Phone
(828) 694-2337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X OTP-0102 SC Primary

Addresses

Primary practice location

103 Pelham Commons Blvd
Greenville, SC 29615-4974

Mailing address

103 Pelham Commons Blvd
Greenville, SC 29615-4974
Phone (864) 241-6688

National Provider Directory

National Provider Directory
Tax ID family
Pavillon Outpatient Services8 organizations share this tax ID, including this one
Part of
Pavillon Outpatient Services

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

125 Pelham Commons Blvd
Greenville, SC 29615
Phone (864) 241-6688

103 Pelham Commons Blvd
Greenville, SC 29615
Phone (864) 241-6688

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1023345139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 PELHAM COMMONS BLVD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154974",
            "telephone_number": "864-241-6688",
            "fax_number": "866-990-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 PELHAM COMMONS BLVD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154974",
            "telephone_number": "864-241-6688",
            "fax_number": "866-990-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILLON GREENVILLE OUTPATIENT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAVILLON INTERNATIONAL",
        "enumeration_date": "2009-11-10",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "KEATOR",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "828-694-2337"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "SC",
            "license": "OTP-0102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.