Basic Information
Provider Information
NPI: 1073137923
EntityType: 2
ReplacementNPI:  
OrganizationName: PLEASANT VALLEY HEALTH CARE CENTER, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PLEASANT VALLEY NURSING AND REHABILITATION CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 279
Address2:  
City: CABIN CREEK
State: WV
PostalCode: 250350279
CountryCode: US
TelephoneNumber: 3043441623
FaxNumber: 3045569165
Practice Location
Address1: 640 SANDHILL RD
Address2:  
City: POINT PLEASANT
State: WV
PostalCode: 255502163
CountryCode: US
TelephoneNumber: 3046754340
FaxNumber: 3046756095
Other Information
ProviderEnumerationDate: 06/05/2020
LastUpdateDate: 07/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: JONES
AuthorizedOfficialFirstName: TODD
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3043441623
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: CPA
NPICertificationDate: 07/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
313M00000X  N Nursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility 
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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