Provider Demographics
NPI:1417966490
Name:PLEASANT VALLEY CSD
Entity Type:Organization
Organization Name:PLEASANT VALLEY CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLINGINGSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-332-5550
Mailing Address - Street 1:525 BELMONT RD
Mailing Address - Street 2:PO BOX 332
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52767-0332
Mailing Address - Country:US
Mailing Address - Phone:563-332-5550
Mailing Address - Fax:563-332-4372
Practice Address - Street 1:525 BELMONT RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:IA
Practice Address - Zip Code:52767-0332
Practice Address - Country:US
Practice Address - Phone:563-332-5550
Practice Address - Fax:563-332-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0457762Medicaid