Provider Demographics
NPI:1871175554
Name:PAVONES HOLDINGS, LLC
Entity type:Organization
Organization Name:PAVONES HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-989-0312
Mailing Address - Street 1:720 SE 160TH AVE STE 103-213
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8911
Mailing Address - Country:US
Mailing Address - Phone:360-989-0312
Mailing Address - Fax:
Practice Address - Street 1:2200 BROADWAY ST STE F
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3255
Practice Address - Country:US
Practice Address - Phone:360-989-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty