Provider Demographics
NPI:1205458759
Name:PLEASANT PARK PLACE LLC
Entity type:Organization
Organization Name:PLEASANT PARK PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ZOCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:218-770-6068
Mailing Address - Street 1:1450 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971
Mailing Address - Country:US
Mailing Address - Phone:920-896-0036
Mailing Address - Fax:920-896-0335
Practice Address - Street 1:1450 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971
Practice Address - Country:US
Practice Address - Phone:920-896-0036
Practice Address - Fax:920-896-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility