Provider Demographics
NPI:1912252362
Name:PATRIARCH HEALTH CARE, LLC
Entity Type:Organization
Organization Name:PATRIARCH HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-613-3641
Mailing Address - Street 1:109 E 17TH ST
Mailing Address - Street 2:SUITE 4293
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 E 17TH ST
Practice Address - Street 2:SUITE 4293
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4543
Practice Address - Country:US
Practice Address - Phone:307-773-7926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health