Provider Demographics
NPI:1063498160
Name:PARK PLEASANT, INC
Entity Type:Organization
Organization Name:PARK PLEASANT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:KLEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-727-4450
Mailing Address - Street 1:4712 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3513
Mailing Address - Country:US
Mailing Address - Phone:215-727-4450
Mailing Address - Fax:215-724-6596
Practice Address - Street 1:4712 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3513
Practice Address - Country:US
Practice Address - Phone:215-727-4450
Practice Address - Fax:215-724-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA420302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007576000003Medicaid
PA0669090001Medicare NSC
PA0007576000003Medicaid