Pavilion Home LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Fredericksburg, VA. Organization (NPI-2).
NPI number1932016128
StatusActive
Last updated in NPPESAug 25, 2026
Details
- NPI
- 1932016128
- Entity type
- Organization (NPI-2)
- Legal business name
- Pavilion Home LLC
- Organization subpart
- No
- Enumeration date
- Aug 25, 2026
- Certification date
- Aug 25, 2026
- Last updated
- Aug 25, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
Practice location
2804 Rose AveFredericksburg, VA 22408-3936
Phone 571-276-0289
Mailing address
2804 Rose AveFredericksburg, VA 22408-3936
Phone 571-276-0289
Authorized official
Veronica Samba
Owner
5712760289
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