Provider Demographics
NPI:1629750427
Name:PLEASANT PINES
Entity Type:Organization
Organization Name:PLEASANT PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME OWNER/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-213-7781
Mailing Address - Street 1:55871 FRANK JONES RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MI
Mailing Address - Zip Code:49072-8731
Mailing Address - Country:US
Mailing Address - Phone:269-496-9667
Mailing Address - Fax:269-496-9765
Practice Address - Street 1:55871 FRANK JONES RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MI
Practice Address - Zip Code:49072-8731
Practice Address - Country:US
Practice Address - Phone:269-496-9667
Practice Address - Fax:269-496-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities