Healthcare Provider Details

I. General information

NPI: 1982651741
Provider Name (Legal Business Name): PLEASANT VIEW LUTHER HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 COLLEGE AVE
OTTAWA IL
61350-3865
US

IV. Provider business mailing address

505 COLLEGE AVE
OTTAWA IL
61350-3865
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-1130
  • Fax: 815-434-1135
Mailing address:
  • Phone: 815-434-1130
  • Fax: 815-434-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0012864
License Number StateIL

VIII. Authorized Official

Name: MR. KARL O NOREM
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-434-1130