MEDICARE: PLEASANT VIEW MANOR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	AM0410377803	MI

General Provider Information

NPI Number	:	1104366921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT VIEW MANOR INC

Provider Business Mailing Address
First Line	:	16000 PINE LAKE AVE
Second Line	:
City	:	SAND LAKE
State	:	MI
Zip	:	49343-9551
Country	:	US
Telephone Number	:	616-696-2400
Fax Number	:	616-696-9073

Provider Business Practice Location Address
First Line	:	16000 PINE LAKE AVE
Second Line	:
City	:	SAND LAKE
State	:	MI
Zip	:	49343-9551
Country	:	US
Telephone Number	:	616-696-2400
Fax Number	:	616-696-9073

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. JULIE KAY BROOKS
Credential	:
Telephone Number	:	616-696-2400

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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