Provider Demographics
NPI:1942473327
Name:PATTERSON HOUSE, INC
Entity Type:Organization
Organization Name:PATTERSON HOUSE, INC
Other - Org Name:PATTERSON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RSD
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:217-728-4357
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 1:307 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-2029
Practice Address - Country:US
Practice Address - Phone:217-728-4357
Practice Address - Fax:217-728-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0037341315P00000X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No343800000XTransportation ServicesSecured Medical Transport (VAN)