Provider Demographics
NPI:1699736850
Name:PLEASANTVILLE CARE CENTER LLC
Entity type:Organization
Organization Name:PLEASANTVILLE CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-9573
Mailing Address - Street 1:909 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50225-9789
Mailing Address - Country:US
Mailing Address - Phone:515-848-5718
Mailing Address - Fax:515-848-5596
Practice Address - Street 1:909 N STATE ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:IA
Practice Address - Zip Code:50225-9789
Practice Address - Country:US
Practice Address - Phone:515-848-5718
Practice Address - Fax:515-848-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA630309314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0804963Medicaid
165324Medicare Oscar/Certification