Provider Demographics
NPI:1326204710
Name:PLEASANT LAKE NURSING HOME, INC.
Entity Type:Organization
Organization Name:PLEASANT LAKE NURSING HOME, INC.
Other - Org Name:PLEASANT LAKE VILLA - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DASKAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-898-8399
Mailing Address - Street 1:7260 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6636
Mailing Address - Country:US
Mailing Address - Phone:440-842-2273
Mailing Address - Fax:
Practice Address - Street 1:7260 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6636
Practice Address - Country:US
Practice Address - Phone:440-842-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0338303291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory