Provider Demographics
NPI:1134116130
Name:BALTIC AVENUE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BALTIC AVENUE ENTERPRISES, LLC
Other - Org Name:DBA PLEASANT VIEW NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHESNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-424-3721
Mailing Address - Street 1:7451 PLEASANT VIEW DR
Mailing Address - Street 2:P.O. BOX 472
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9462
Mailing Address - Country:US
Mailing Address - Phone:330-424-3721
Mailing Address - Fax:330-424-7426
Practice Address - Street 1:7451 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9462
Practice Address - Country:US
Practice Address - Phone:330-424-3721
Practice Address - Fax:330-424-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5631314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124525Medicaid
OH366287Medicare ID - Type UnspecifiedMEDICARE NUMBER