Provider Demographics
NPI:1780719286
Name:PATTERSON HOME CARE, INC.
Entity type:Organization
Organization Name:PATTERSON HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAROLETTE
Authorized Official - Middle Name:BOUVIER
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-8427
Mailing Address - Street 1:PO BOX 64013
Mailing Address - Street 2:6331 RANNOCK DR.
Mailing Address - City:FAY
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-527-8427
Mailing Address - Fax:910-822-8202
Practice Address - Street 1:6331 RANNOCK DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-527-8427
Practice Address - Fax:910-822-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 026766320600000X
320900000X
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities