Pavilion Pace, LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

PAVILION PACE, LLC

Practice address

4115 Annandale Rd Ste 100
Annandale, VA 22003-2583

Phone

(240) 346-7488

Fax

(703) 226-5604

NPI assigned

Jun 25, 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

Ceo

Phone

(240) 346-7488

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1750809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1164310496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 100",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032583",
            "telephone_number": "240-346-7488",
            "fax_number": "703-226-5604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 100",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032583",
            "telephone_number": "240-346-7488",
            "fax_number": "703-226-5604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION PACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-25",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "ERHUNMWUNSE",
        "authorized_official_first_name": "GIBSON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-346-7488",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• PACE Provider Organization in Annandale, VA
• Providers in Annandale, VA by specialty
• PACE Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.