Provider Demographics
NPI:1891506283
Name:PLEASANT VALLEY ADULT CARE HOME LLC
Entity type:Organization
Organization Name:PLEASANT VALLEY ADULT CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-826-6188
Mailing Address - Street 1:9146 W QUAIL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5148
Mailing Address - Country:US
Mailing Address - Phone:602-826-6188
Mailing Address - Fax:
Practice Address - Street 1:9146 W QUAIL TRACK DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-5148
Practice Address - Country:US
Practice Address - Phone:602-826-6188
Practice Address - Fax:623-236-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility