Provider Demographics
NPI:1043874985
Name:PLEASANTVILLE HOME CARE AGENCY
Entity Type:Organization
Organization Name:PLEASANTVILLE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:414-759-6059
Mailing Address - Street 1:4200 N HOLTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1064
Mailing Address - Country:US
Mailing Address - Phone:414-909-0296
Mailing Address - Fax:414-962-4003
Practice Address - Street 1:4200 N HOLTON ST STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1064
Practice Address - Country:US
Practice Address - Phone:414-909-0296
Practice Address - Fax:414-962-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health