Provider Demographics
NPI:1144217332
Name:PLEASANT RIDGE MANOR
Entity Type:Organization
Organization Name:PLEASANT RIDGE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-474-5521
Mailing Address - Street 1:8300 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-8701
Mailing Address - Country:US
Mailing Address - Phone:814-474-5521
Mailing Address - Fax:814-474-9253
Practice Address - Street 1:8300 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-8701
Practice Address - Country:US
Practice Address - Phone:814-474-5521
Practice Address - Fax:814-474-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA311002314000000X
PA050902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0536OtherBLUE CROSS
PA1007744350006Medicaid
PA0536OtherBLUE CROSS