Patterson House, Inc.
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Canton, IL
NPI 1548433154 · NPPES record last updated Jun 24, 2008
Key facts
- NPI
- 1548433154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 0039354 (IL)
- Legal business name
- PATTERSON HOUSE, INC.
- Practice address
- 1577 E Myrtle St
Canton, IL 61520-1520 - Phone
- (309) 647-6604
- Fax
- (309) 647-0440
- NPI assigned
- Apr 4, 2008
- Organization subpart
- No
Authorized official
- Name
- Ms. Marcia Rose, QMRP
- Title
- RSD
- Phone
- (309) 647-6604
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Patterson House Inc
Locations
1577 E Myrtle St
Canton, IL 61520
Phone (309) 647-6604
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0039354 | IL | Yes |
| Non-emergency Medical Transport (VAN) | 343900000X | 0039354 | IL |
Addresses
Primary practice location
1577 E Myrtle St
Canton, IL 61520-1520
Mailing address
PO Box 25527
Decatur, IL 62525-5527
Phone (217) 422-6510
Other names
- Emerald Estades
Other providers in Canton, IL
- Alicia Nelson
- North Central Behavioral Health Systems, Inc.
- North Central Behavioral Health Systems, Inc.
- Erin P. O'Brien
- Brent D Parry
- Petersen Health Care
- Petersen Health Care, Inc.
- Petersen Health Junction, LLC
- Ella Kief Peterson
- Benjamin William Phillips
All providers in Canton, IL · Intellectual Disabilities Intermediate Care Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.