Provider Demographics
NPI:1073786562
Name:PATTERSON HOUSE, INC.
Entity Type:Organization
Organization Name:PATTERSON HOUSE, INC.
Other - Org Name:MARIGOLD ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RSD
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:309-347-6514
Mailing Address - Street 1:PO BOX 25527
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62525-5527
Mailing Address - Country:US
Mailing Address - Phone:217-422-6510
Mailing Address - Fax:217-422-6819
Practice Address - Street 1:3240 BARNEY AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6233
Practice Address - Country:US
Practice Address - Phone:309-347-6514
Practice Address - Fax:309-347-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039370315P00000X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No343800000XTransportation ServicesSecured Medical Transport (VAN)