Provider Demographics
NPI:1992539472
Name:PAVILION BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PAVILION BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DZAIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-353-2368
Mailing Address - Street 1:99855 HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-6073
Mailing Address - Country:US
Mailing Address - Phone:479-353-2368
Mailing Address - Fax:
Practice Address - Street 1:99855 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:VIAN
Practice Address - State:OK
Practice Address - Zip Code:74962-6073
Practice Address - Country:US
Practice Address - Phone:479-353-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty