NPIMap

Organization Active NPI

Pavillon Greenville Outpatient Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Greenville, SC
National Provider Identifier
1780934976
Registry record updated Mar 11, 2015
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
101 Pelham Commons Blvd
Greenville, SC 29615-4974
Phone
(864) 241-6688
Fax
(864) 241-6682
NPI assigned
Sep 14, 2012
Organization subpart
Yes
Parent organization
PAVILLON INTERNATIONALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2015

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

Authorized official

Name
Ms. Natalie Fryar, LPC, CACII
Title
Program Manager
Phone
(864) 241-6688

Specialties & licenses 1

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

Addresses

Primary practice location

101 Pelham Commons Blvd
Greenville, SC 29615-4974

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1023345139OtherSCNPI

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

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1780934976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PELHAM COMMONS BLVD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154974",
            "telephone_number": "864-241-6688",
            "fax_number": "864-241-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PELHAM COMMONS BLVD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154974",
            "telephone_number": "864-241-6688",
            "fax_number": "864-241-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILLON GREENVILLE OUTPATIENT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAVILLON INTERNATIONAL",
        "enumeration_date": "2012-09-14",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "FRYAR",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "864-241-6688",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, CACII"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "SC",
            "license": "OTP 0102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1023345139",
            "state": "SC"
        }
    ],
    "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 Mar 11, 2015; 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.