Pavilion Legacy Hospice & Palliative Care, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PAVILION LEGACY HOSPICE & PALLIATIVE CARE, LLC

Practice address

4115 Annandale Rd Ste 200
Annandale, VA 22003-2500

Phone

(240) 346-7488

NPI assigned

Jul 29, 2025

Organization subpart

No

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

Authorized official

Name

Gibson Erhunmwunse, DNP

Title

Chief Executive Officer

Phone

(240) 346-7488

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1124901905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 200",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032500",
            "telephone_number": "240-346-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 200",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032500",
            "telephone_number": "240-346-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION LEGACY HOSPICE & PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "ERHUNMWUNSE",
        "authorized_official_first_name": "GIBSON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "240-346-7488",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Annandale, VA
• Providers in Annandale, VA by specialty
• Community Based Hospice Care Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.