Provider Demographics
NPI:1316216179
Name:THE PATARY, INC
Entity Type:Organization
Organization Name:THE PATARY, INC
Other - Org Name:THE CRESTVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-678-8927
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-1103
Mailing Address - Country:US
Mailing Address - Phone:606-678-8927
Mailing Address - Fax:606-679-6515
Practice Address - Street 1:235 S RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2033
Practice Address - Country:US
Practice Address - Phone:606-678-8927
Practice Address - Fax:606-679-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100370311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home