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General NPI Number Information
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NPI Number | 1619091774
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Entity Type | Organization
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Legal Business Name | PLEASANT MANOR, INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 41 BRAND AVENUE
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City | FARIBAULT
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State | MN
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Zip | 55021-6411
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Country | US
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Telephone | 507-333-5960
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Fax |
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Provider Business Mailing Address
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Address Line | 41 BRAND AVENUE
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City | FARIBAULT
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State | MN
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Zip | 55021-6411
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Country | US
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Telephone | 507-333-5960
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS BONNIE CAMPEAU
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Credential | LNHA
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Telephone | 507-334-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 333922
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License Number State | MN
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