Organization
PATTERSON HOUSE, INC.
Active
Other names
Emerald Estades
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARCIA ROSE QMRP (RSD)
(309) 647-6604
Entity
Organization
Contact information
Practice address
1577 E MYRTLE ST, CANTON, IL 61520-1520
(309) 647-6604
(309) 647-0440
Mailing address
PO BOX 25527, DECATUR, IL 62525-5527
(217) 422-6510
(217) 422-6819
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0039354
IL
343900000X
Non-emergency Medical Transport (VAN)
0039354
IL
Other
Enumeration date
04/04/2008
Last updated
06/24/2008
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