Provider Demographics
NPI:1245908029
Name:PATAKY ENTERPRISES LLC
Entity type:Organization
Organization Name:PATAKY ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PATAKY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-237-4830
Mailing Address - Street 1:101 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1210
Mailing Address - Country:US
Mailing Address - Phone:573-237-4830
Mailing Address - Fax:573-237-4831
Practice Address - Street 1:101 ARIZONA ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1210
Practice Address - Country:US
Practice Address - Phone:573-237-4830
Practice Address - Fax:573-237-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness