Provider Demographics
NPI:1982486460
Name:PAVILION HOME CARE LLC
Entity type:Organization
Organization Name:PAVILION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDIEBERE
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-495-1315
Mailing Address - Street 1:6002 SOLEDAD PINE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1045
Mailing Address - Country:US
Mailing Address - Phone:832-455-3394
Mailing Address - Fax:
Practice Address - Street 1:6002 SOLEDAD PINE CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1045
Practice Address - Country:US
Practice Address - Phone:832-495-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care