1427326289 NPI number — THE PAVILION AT WILLIAMSBURG PLACE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427326289 NPI number — THE PAVILION AT WILLIAMSBURG PLACE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PAVILION AT WILLIAMSBURG PLACE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE PAVILION AT WILLIAMSBURG PLACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427326289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIGHTFOOT
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23090-0087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-941-5095
Provider Business Mailing Address Fax Number:
757-565-2947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5483 MOORETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-941-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
615-716-4924

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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