Provider Demographics
NPI:1285802165
Name:PAVISCH TREATMENT CENTERS, LLC
Entity type:Organization
Organization Name:PAVISCH TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SCHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-769-8973
Mailing Address - Street 1:185 KETTLE CRK
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7313
Mailing Address - Country:US
Mailing Address - Phone:951-769-8973
Mailing Address - Fax:
Practice Address - Street 1:4241 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3027
Practice Address - Country:US
Practice Address - Phone:951-785-1571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330088AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility