Provider Demographics
NPI:1548433154
Name:PATTERSON HOUSE, INC.
Entity Type:Organization
Organization Name:PATTERSON HOUSE, INC.
Other - Org Name:EMERALD ESTADES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RSD
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:309-647-6604
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 1:1577 E MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1520
Practice Address - Country:US
Practice Address - Phone:309-647-6604
Practice Address - Fax:309-647-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039354315P00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)