PAVILION GUEST HOME (NPI# 1194861716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194861716 |
| Entity Type | Organization |
| Organization Name | PAVILION GUEST HOME |
| Practice Address |
2955 E Mallory St Mesa AZ 85213-1667 |
| Mailing Address |
2955 E. Mallory St. Mesa AZ 85213 |
| Practice Telephone | 4806548329 |
| Practice Fax Number | 4808304113 |
| Mailing Telephone | 4806548329 |
| Mailing Fax Number | 4808304113 |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MARIETA G. HUGO (OWNER) |
| Authorized Official Telephone | 4806548329 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
ALH 4489 | AZ | Nursing & Custodial Care Facilities |
| Street Address |
2955 E MALLORY ST |
| City | MESA |
| State | AZ |
| Zip Code | 85213-1667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962855296 | Angelo Acsayan | Assisted Living Facility | 2955 E Mallory St, Mesa, AZ 85213-1667 | 2016-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861041733 | Belinda Wiens | Counselor | 2135 E University Dr., Suite 116, Mesa, AZ 85213 | 2019-09-04 |
| 1679099402 | Roxanne Nicole Greene | Physical Therapist | 2642 E Fairfield St, Mesa, AZ 85213 | 2017-08-14 |
| 1861921405 | Cameron Kastl | Dentist | 820 E University Dr, Mesa, AZ 85213 | 2017-06-07 |
| 1033667860 | Ricardo Helaman Perez | Dentist | 459 North Val Vista Drive, Mesa, AZ 85213 | 2016-09-21 |
| 1902221039 | The U-turn Foundation | Psychiatric Residential Treatment Facility | 2941 E Contessa St., Mesa, AZ 85213 | 2014-02-26 |
| 1720354194 | Roberta Lynn Ray | Registered Nurse | 824 N Gentry St., Mesa, AZ 85213 | 2012-03-29 |
| 1639483647 | William Lawrence Hull IIi | Dentist | 2855 E Brown Rd Ste 5, Mesa, AZ 85213 | 2010-08-02 |
| 1619299286 | Arizona Internal Medicine Associates LLC | Internal Medicine | 3435 E. Kael St, Mesa, AZ 85213 | 2010-02-23 |
| 1568691863 | Kathleen Ann Ruffin | Dental Hygienist | 2855 E. Brown Rd, Suite 15, Mesa, AZ 85213 | 2009-07-08 |
| 1356584890 | Sw Sports Medicine & Orthopedic Surgery | Orthopaedic Surgery | 2835 E. Brown Rd., Ste. 101, Mesa, AZ 85213 | 2009-04-14 |
| Find all providers in zip 85213 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932728581 | Michael Ford | Custodial Care Facility | 10462 E Abilene Ave, Mesa, AZ 85208-8717 | 2020-04-14 |
| 1366977506 | Woodward Foundation for The Disabled | Custodial Care Facility | 33 S Sycamore, Suite 1, Mesa, AZ 85202-1150 | 2017-04-25 |
| 1275071433 | Anderson Assisted Living Homes, LLC | Custodial Care Facility | 9831 E Broadway Rd, Mesa, AZ 85208-2505 | 2017-02-08 |
| 1447525324 | Family Care Homes, Inc. | Custodial Care Facility | 1511 N Gilbert Rd, Mesa, AZ 85203-3902 | 2012-03-12 |
| 1114296332 | Life Sonoran Homnes | Custodial Care Facility | 2036 E Calle Maderas, Mesa, AZ 85213-2910 | 2011-12-16 |
| 1174815302 | Better Living Carehome LLC | Custodial Care Facility | 9321 E Carmel Ave, Mesa, AZ 85208-5834 | 2011-05-05 |
| 1003081860 | M E D Services | Custodial Care Facility | 3759 E Clovis Ave, Mesa, AZ 85206-1841 | 2008-04-23 |
| 1609041458 | M E D Services | Custodial Care Facility | 3065 S Canfield Cir, Mesa, AZ 85212 | 2008-04-23 |
| 1154511202 | Third Street Home | Custodial Care Facility | 1053 E 3rd St, Mesa, AZ 85203-8001 | 2007-07-25 |
| 1730382862 | Lauras Assisted Living | Custodial Care Facility | 1338 W Lobo Ave, Mesa, AZ 85202-6651 | 2007-06-06 |
| Find all providers in MESA | ||||
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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.