Healthcare Provider Details

I. General information

NPI: 1699736850
Provider Name (Legal Business Name): PLEASANTVILLE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N STATE ST
PLEASANTVILLE IA
50225-9789
US

IV. Provider business mailing address

909 N STATE ST
PLEASANTVILLE IA
50225-9789
US

V. Phone/Fax

Practice location:
  • Phone: 515-848-5718
  • Fax: 515-848-5596
Mailing address:
  • Phone: 515-848-5718
  • Fax: 515-848-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number630309
License Number StateIA

VIII. Authorized Official

Name: MICHELLE ZIMBELMAN
Title or Position: MANAGER
Credential:
Phone: 816-232-9573