Provider Demographics
NPI:1568455509
Name:PLEASANT VALLEY HOSPITAL
Entity Type:Organization
Organization Name:PLEASANT VALLEY HOSPITAL
Other - Org Name:PLEASANT VALLEY PRIVATE DUTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-675-7400
Mailing Address - Street 1:1011 VIAND ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1242
Mailing Address - Country:US
Mailing Address - Phone:304-675-7400
Mailing Address - Fax:304-675-7401
Practice Address - Street 1:1011 VIAND ST
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1242
Practice Address - Country:US
Practice Address - Phone:304-675-7400
Practice Address - Fax:304-675-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV06251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001300006Medicaid
OH2084097Medicaid