Provider Demographics
NPI:1043236417
Name:PLEASANT CARE CORPORATION
Entity Type:Organization
Organization Name:PLEASANT CARE CORPORATION
Other - Org Name:EMMANUEL HEALTH CARE CHARLESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-9808
Mailing Address - Street 1:2258 FOOTHILL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1476
Mailing Address - Country:US
Mailing Address - Phone:818-248-9808
Mailing Address - Fax:818-541-7072
Practice Address - Street 1:2035 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2223
Practice Address - Country:US
Practice Address - Phone:650-583-8937
Practice Address - Fax:650-583-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1182SNF-7314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV19-02545Medicaid
29-5040Medicare ID - Type UnspecifiedMUTUAL OF OMAHA