NPI 1164310496

Pavilion Pace, LLC

Organisation PACE Provider Organization Annandale, VA

Practice location

Address: 4115 Annandale Rd STE 100, Annandale, VA 22003-2583
Phone: (240) 346-7488
Fax: (703) 226-5604

Authorised official

Name: Gibson Erhunmwunse
Title: Ceo
Phone: (240) 346-7488

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

Other Program of All-Inclusive Care for the Elderly (PACE) Provider Organization providers in Virginia →

Registry record

NPI: 1164310496
Entity type: Organization
NPI issued: 25 Jun 2025
Record last updated: 25 Jun 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.