Pavilion Guest Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALH 4489 Issued in AZ

Legal business name

PAVILION GUEST HOME

Practice address

2955 E Mallory St
Mesa, AZ 85213-1667

Phone

(480) 654-8329

Fax

(480) 830-4113

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Marieta G. Hugo

Title

Owner

Phone

(480) 654-8329

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194861716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2955 E. MALLORY ST.",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85213",
            "telephone_number": "480-654-8329",
            "fax_number": "480-830-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 E MALLORY ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852131667",
            "telephone_number": "480-654-8329",
            "fax_number": "480-830-4113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION GUEST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUGO",
        "authorized_official_first_name": "MARIETA",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-654-8329"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH 4489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayley Paul
• Mardi K Pauling, RPH
• Amy K Paulino, RN
• Eileen Diane Paull, RN
• Joel D Pavelonis, MD
• Pavillion
• Leigh Pavlik, PA-C
• Courtney Rebecca Pavone, LAC
• Laureen D Pavtis, DC
• Jeffrey Pawlowski, DPM

• Adult Care Home Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.