Provider Demographics
NPI:1598975120
Name:PLEASANT VALLEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:PLEASANT VALLEY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-4340
Mailing Address - Street 1:2520 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2031
Mailing Address - Country:US
Mailing Address - Phone:304-675-4340
Mailing Address - Fax:304-675-5893
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-4340
Practice Address - Fax:304-675-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
WV6282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH114569Medicaid
OH6975457Medicaid
WV0001300000Medicaid
WV039805700OtherFEDERAL BLACK LUNG
WV000324347Medicaid
WV000324347Medicaid
WV000324347Medicaid