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NPI Code Detail

MEDICARE: PATE REHABILITATION ENDEAVORS, LLC

MEDICARE: PATE REHABILITATION ENDEAVORS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QM2500XMedical Specialty Clinic/Center
3261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1083738892
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATE REHABILITATION ENDEAVORS, LLC
Provider Business Mailing Address
First Line : 805 N WHITTINGTON PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-7101
Country : US
Telephone Number : 502-394-2100
Fax Number : 502-394-2159
Provider Business Practice Location Address
First Line : 8222 N BELT LINE RD STE 175
Second Line :
City : IRVING
State : TX
Zip : 75063-2276
Country : US
Telephone Number : 972-514-6032
Fax Number : 972-514-6054
Authorized Official
Title or Position : VICE PRESIDENT & MANAGER
Name : MS. MARGARET SHERRY PEMBERTON
Credential :
Telephone Number : 502-394-3231
Provider Enumeration Date : 03/19/2007
Last Update Date : 12/26/2023

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