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General NPI Number Information
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NPI Number | 1558663799
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Entity Type | Organization
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Legal Business Name | PLEASANT HOME INC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 485 WAYLAND RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-3412
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Country | US
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Telephone | 321-984-8688
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Fax | 321-953-4515
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Provider Business Mailing Address
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Address Line | 485 WAYLAND RD SW
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City | PALM BAY
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State | FL
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Zip | 32908-3412
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Country | US
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Telephone | 321-984-8688
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Fax | 321-953-4515
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS RUTH ELIZABETH SOMERVILLE
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Credential | C.N.A
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Telephone | 321-984-8688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | AL7646
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License Number State | FL
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