Basic Information
| Provider Information | |||||||||
| NPI: | 1649237397 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEXION HEALTH AT PATTERSON, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PATTERSON HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 PROGRESS WAY | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217846429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105524800 | ||||||||
| FaxNumber: | 4105524837 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 LIA ST | ||||||||
| Address2: | |||||||||
| City: | PATTERSON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703924220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853954563 | ||||||||
| FaxNumber: | 9853956533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KIRLEY | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4105524800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 846 | LA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1510530 | 05 | LA | MEDICAID |