Provider Demographics
NPI:1528649340
Name:PATTILLY ENTERPRISES, INC.
Entity type:Organization
Organization Name:PATTILLY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-649-0662
Mailing Address - Street 1:7900 TRINITY SHORE CIR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8318
Mailing Address - Country:US
Mailing Address - Phone:573-649-0662
Mailing Address - Fax:
Practice Address - Street 1:1104 S MAYS ST STE 117
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6769
Practice Address - Country:US
Practice Address - Phone:512-580-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health