Provider Demographics
NPI:1184222424
Name:PATTON HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PATTON HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-360-8784
Mailing Address - Street 1:2 W 21ST ST STE A7
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5904
Mailing Address - Country:US
Mailing Address - Phone:240-360-8784
Mailing Address - Fax:443-453-9132
Practice Address - Street 1:2 W 21ST ST STE A7
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5904
Practice Address - Country:US
Practice Address - Phone:240-360-8784
Practice Address - Fax:443-453-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5951035400Medicaid