Provider Demographics
NPI:1922164466
Name:PLEASANT VALLEY MANOR, INC.
Entity Type:Organization
Organization Name:PLEASANT VALLEY MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POPPITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-992-4172
Mailing Address - Street 1:4227 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9451
Mailing Address - Country:US
Mailing Address - Phone:570-992-4172
Mailing Address - Fax:570-992-0324
Practice Address - Street 1:4227 MANOR DR
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9451
Practice Address - Country:US
Practice Address - Phone:570-992-4172
Practice Address - Fax:570-992-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA161702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008619590002Medicaid
PA0008619590002Medicaid