NPIMap

Organization Active NPI

Patterson House, Inc.

Doing business as Marigold Estates

  • Intellectual Disabilities Intermediate Care Facility
  • Pekin, IL
National Provider Identifier
1073786562
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0039370 Issued in IL
Legal business name
PATTERSON HOUSE, INC.
Doing business as
Marigold Estates
Practice address
3240 Barney Ave
Pekin, IL 61554-6233
Phone
(309) 347-6514
Fax
(309) 347-6146
NPI assigned
Apr 7, 2008
Last updated
Jun 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Rich Sloan, QMRP
Title
RSD
Phone
(309) 347-6514

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0039370 IL Primary
Secured Medical Transport (VAN) 343800000X 0039370 IL

Addresses

Primary practice location

3240 Barney Ave
Pekin, IL 61554-6233

Mailing address

PO Box 25527
Decatur, IL 62525-5527
Phone (217) 422-6510

Other names 1

  • Marigold Estates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073786562. Details of each certification follow.

  • CCN 14G225 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G225

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MARIGOLD ESTATES
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 18, 1989
Last certification
Oct 9, 2024
Beds
16
Ownership / control type
Private (proprietary)
Facility address
3240 Barney Avenue
Pekin, IL 61554

National Provider Directory

National Provider Directory
Tax ID family
Patterson House Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3240 Barney Ave
Pekin, IL 61554
Phone (309) 347-6514

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1073786562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25527",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625255527",
            "telephone_number": "217-422-6510",
            "fax_number": "217-422-6819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 BARNEY AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546233",
            "telephone_number": "309-347-6514",
            "fax_number": "309-347-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATTERSON HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "SLOAN",
        "authorized_official_first_name": "RICH",
        "authorized_official_title_or_position": "RSD",
        "authorized_official_telephone_number": "309-347-6514",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QMRP"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0039370",
            "primary": true
        },
        {
            "code": "343800000X",
            "taxonomy_group": "",
            "desc": "Secured Medical Transport (VAN)",
            "state": "IL",
            "license": "0039370",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marigold Estates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pekin, IL

Sources for this page

Verify at the official NPI Registry.