Pavilion Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2308078 Issued in OH

Legal business name

PAVILION CARE CENTER LLC

Doing business as

The Pavilion

Practice address

705 Fulton St
Sidney, OH 45365-3203

Phone

(937) 492-9591

Fax

(937) 498-0529

NPI assigned

Feb 21, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Carol J Groeber

Title

Vice President/Mis

Phone

(937) 964-8974

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Pavilion Doing business as

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1073588141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "937-492-9591",
            "fax_number": "937-498-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "937-492-9591",
            "fax_number": "937-498-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "GROEBER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT/MIS",
        "authorized_official_telephone_number": "937-964-8974",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2308078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2308078",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Sidney, OH
• Providers in Sidney, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.