Provider Demographics
NPI:1558663799
Name:PLEASANT HOME INC
Entity Type:Organization
Organization Name:PLEASANT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:321-984-8688
Mailing Address - Street 1:485 WAYLAND RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3412
Mailing Address - Country:US
Mailing Address - Phone:321-984-8688
Mailing Address - Fax:321-953-4515
Practice Address - Street 1:485 WAYLAND RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-3412
Practice Address - Country:US
Practice Address - Phone:321-984-8688
Practice Address - Fax:321-953-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7646261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health