MEDICARE: PLEASANT 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	314000000X	Skilled Nursing Facility	326599	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	270543500	OTHER	MN	DHS PROVIDER NUMBER

General Provider Information

NPI Number	:	1982607271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT MANOR, INC.

Provider Business Mailing Address
First Line	:	27 BRAND AVE
Second Line	:
City	:	FARIBAULT
State	:	MN
Zip	:	55021-6411
Country	:	US
Telephone Number	:	507-334-2036
Fax Number	:	507-334-3558

Provider Business Practice Location Address
First Line	:	27 BRAND AVE
Second Line	:
City	:	FARIBAULT
State	:	MN
Zip	:	55021-6411
Country	:	US
Telephone Number	:	507-334-2036
Fax Number	:	507-334-3558

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS BONNIE CAMPEAU
Credential	:	LNHA
Telephone Number	:	507-334-2036

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/11/2013

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Directions to “PLEASANT MANOR, INC. ” Practice Location

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