Provider Demographics
NPI:1427002559
Name:PLEASANT VIEW NURSING HOME OF MT. AIRY, INC.
Entity Type:Organization
Organization Name:PLEASANT VIEW NURSING HOME OF MT. AIRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-829-0800
Mailing Address - Street 1:4101 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-4115
Mailing Address - Country:US
Mailing Address - Phone:301-829-0800
Mailing Address - Fax:410-442-4697
Practice Address - Street 1:4101 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4115
Practice Address - Country:US
Practice Address - Phone:301-829-0800
Practice Address - Fax:410-442-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13052314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06-3607000Medicaid
MD06-3607000Medicaid