# PAVILION MEDICAL HOME CARE & STAFFING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PAVILION MEDICAL HOME CARE & STAFFING, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376620120
- **Legal business name:** PAVILION MEDICAL HOME CARE & STAFFING, LLC
- **Authorized official:** MR. GIBSON IYEKE ERHUNMWUNSE CRNP (CEO)
- **Authorized official phone:** (703) 299-9898

## Contact information

- **Practice address:** 4115 ANNANDALE RD, SUITE 202, ANNANDALE, VA 22003-2500
- **Practice address phone:** (703) 299-9898
- **Practice address fax:** (703) 299-9595
- **Mailing address:** 4115 ANNANDALE RD, SUITE 202, ANNANDALE, VA 22003-2500
- **Mailing address phone:** (703) 299-9898
- **Mailing address fax:** (703) 299-9595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | HCO-O7389 | VA | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 02/22/2012