PAVILLION HEALTHCARE SERVICES (NPI# 1124163100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124163100 |
| Entity Type | Organization |
| Organization Name | PAVILLION HEALTHCARE SERVICES |
| Practice Address |
20930 Bonita St Suite Y Carson CA 90746-3680 |
| Practice Telephone | 3105323464 |
| Mailing Telephone | 3105323464 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARTIN OKON (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 3105323464 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 59793A | CA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 7163 | 05 |
| Street Address |
20930 BONITA ST SUITE Y |
| City | CARSON |
| State | CA |
| Zip Code | 90746-3680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396744884 | Tiburcio Paz Alberto | General Practice | 20930 Bonita St, Suite W, Carson, CA 90746-3683 | 2005-07-18 |
| 1154722254 | Dominguez Hills Dental Group | Dentist | 20930 Bonita St, Suite T, Carson, CA 90746-3680 | 2014-09-08 |
| 1821411968 | Lenise N. Yarber D.d.s, Professional Dental Corporation | Dentist | 20930 Bonita St, Suite Y, Carson, CA 90746-3680 | 2014-01-25 |
| 1316254659 | Cappie Baker | Dentist | 20930 Bonita St, Suite X, Carson, CA 90746-3680 | 2010-09-08 |
| 1609108950 | Sylvernus Ebiriekwe | Counselor | 20930 Bonita St, Suite Y, Carson, CA 90746-3680 | 2010-02-10 |
| 1063744316 | Martin Okon | Counselor | 20930 Bonita St, Sute Y, Carson, CA 90746-3680 | 2010-02-10 |
| 1477702934 | Cappie Baker, Dds, Ms, A Professional Corporation | Dentist | 20930 Bonita St, Suite X, Carson, CA 90746-3680 | 2008-09-09 |
| 1770753618 | Peter Oziegbe | Counselor | 20930 Bonita St, Suite Y, Carson, CA 90746-3680 | 2008-03-06 |
| 1639354400 | Dalia Karina Demara | Counselor | 20930 Bonita St, Suite Y, Carson, CA 90746-3680 | 2007-12-29 |
| 1609057520 | Dezella Marie Banks | Counselor | 20930 Bonita St, Suite Y, Carson, CA 90746-3680 | 2007-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174172837 | Darren Nakano Chiropractic, Professional Corporation | Chiropractor | 460 East Carson Plaza Drive, Suite 116, Carson, CA 90746 | 2019-09-05 |
| 1205370079 | Natalie Bland | Nurse Practitioner | 454 E. Carson Plaza Drive Suite 211, Carson, CA 90746 | 2016-12-13 |
| 1891146767 | Francis O Okpan | Nurse Practitioner | 17546 Buttonwood Ln, Carson, CA 90746 | 2016-06-22 |
| 1689049371 | Fresenius Medical Care Long Beach, LLC | Clinic/Center | 20710 Leapwood Ave Ste E, Carson, CA 90746 | 2015-12-07 |
| 1447649108 | Brandi Glenn | Occupational Therapist | 17811 Hazelwood Court, Carson, CA 90746 | 2015-01-20 |
| 1700226263 | Allen Berger | Counselor | 460 Est. Carson Plaza Dr. #119, Carson, CA 90746 | 2013-06-28 |
| 1902147036 | Basen Inc | Counselor | 460 Carson Plaza Drive, Ste 106, Carson, CA 90746 | 2013-03-14 |
| 1811238298 | Basen Inc | Counselor | 460 E Carsin Plaza Dr, #106, Carson, CA 90746 | 2013-03-08 |
| 1871858084 | Joseph H. Rodd M.d. Inc | Psychiatry & Neurology | 20710 S. Leapwood Ave., Suite B, Carson, CA 90746 | 2012-07-13 |
| 1467718601 | Laquesha Shonte Robinson | Counselor | 460 E. Carson Plaza Drive, Suite 200, Carson, CA 90746 | 2012-04-02 |
| Find all providers in zip 90746 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073140430 | Deionna Lakeisha Souder | Community/Behavioral Health | 17861 Alderwood Ct, Carson, CA 90746-1694 | 2020-03-25 |
| 1437402203 | American Drug Recovery Program, Inc. | Community/Behavioral Health | 21828 Avalon Blvd, Carson, CA 90745-3303 | 2012-10-18 |
| 1720334014 | American Drug Recovery Program Inc | Community/Behavioral Health | 21805 Avalon Blvd, Carson, CA 90745-3304 | 2012-07-24 |
| 1306111265 | Dixon Recovery Institute,inc. 2 | Community/Behavioral Health | 500 E Carson Plaza Dr Ste 103, Carson, CA 90746-7323 | 2012-03-12 |
| 1851664726 | Hacc Inc | Community/Behavioral Health | 22328 Main St, Carson, CA 90745-4525 | 2012-02-22 |
| 1437476660 | Be Well Now Institute | Community/Behavioral Health | 20710 Leapwood Ave Ste C, Carson, CA 90746-3646 | 2010-04-28 |
| 1639332133 | Counseling & Research Associates, Inc. | Community/Behavioral Health | 21820 Bonita St, Carson, CA 90745-3404 | 2008-07-03 |
| 1023290640 | Grace Care Corporation | Community/Behavioral Health | 500 E Carson Plaza Dr Ste 101-109, Carson, CA 90746-3225 | 2007-12-05 |
| 1912036518 | Optimist Boys' Home and Ranch | Community/Behavioral Health | 20209 Tillman Ave, Carson, CA 90746-3066 | 2007-03-02 |
| 1467997403 | Koinonia Foster Homes Inc | Community/Behavioral Health | 550 E Carson Plaza Dr, Ste.200, Carson, CA 90746-3229 | 2016-12-29 |
| Find all providers in CARSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.