Provider Demographics
NPI:1083738892
Name:PATE REHABILITATION ENDEAVORS, LLC
Entity Type:Organization
Organization Name:PATE REHABILITATION ENDEAVORS, LLC
Other - Org Name:PATE REHABILITATION - BCR ANNEX
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT & MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:SHERRY
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-3231
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:502-394-2100
Mailing Address - Fax:502-394-2159
Practice Address - Street 1:8222 N BELT LINE RD STE 175
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2276
Practice Address - Country:US
Practice Address - Phone:972-514-6032
Practice Address - Fax:972-514-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QM2500X, 261QR0400X
TX117595310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J74AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER