Provider Demographics
NPI:1043218738
Name:PLEASANT VALLEY NURSING, LLC
Entity Type:Organization
Organization Name:PLEASANT VALLEY NURSING, LLC
Other - Org Name:PLEASANT VALLEY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:613 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SEDAN
Mailing Address - State:KS
Mailing Address - Zip Code:67361-1406
Mailing Address - Country:US
Mailing Address - Phone:620-725-3153
Mailing Address - Fax:620-725-5536
Practice Address - Street 1:613 E ELM ST
Practice Address - Street 2:
Practice Address - City:SEDAN
Practice Address - State:KS
Practice Address - Zip Code:67361-1406
Practice Address - Country:US
Practice Address - Phone:620-725-3153
Practice Address - Fax:620-725-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN010002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0100110180Medicaid
KS0100110180Medicaid