Provider Demographics
NPI:1720281975
Name:PLEASANT VALLEY NURSING AND REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:PLEASANT VALLEY NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-4340
Mailing Address - Street 1:640 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2163
Mailing Address - Country:US
Mailing Address - Phone:304-675-5236
Mailing Address - Fax:304-675-2805
Practice Address - Street 1:640 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2163
Practice Address - Country:US
Practice Address - Phone:304-675-5236
Practice Address - Fax:304-675-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV06313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000324425OtherBCBS
WV55044008603OtherWORKERS COMPENSATION
WV0001300001Medicaid
WV0626170001Medicare NSC
WV=========03OtherWORKERS COMPENSATION