Healthcare Provider Details

I. General information

NPI: 1659543296
Provider Name (Legal Business Name): PLEASANT VALLEY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DR
PT PLEASANT WV
25550-2031
US

IV. Provider business mailing address

2520 VALLEY DR
PT PLEASANT WV
25550-2031
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-1020
  • Fax: 304-675-5893
Mailing address:
  • Phone: 304-675-1020
  • Fax: 304-675-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number6
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1246
License Number StateWV

VIII. Authorized Official

Name: TASHA GROVES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 304-675-4340