Provider Demographics
NPI:1245689231
Name:PLEASANT VINE HOME CARE LLC
Entity type:Organization
Organization Name:PLEASANT VINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGU
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:610-226-2121
Mailing Address - Street 1:130 W MAIN ST
Mailing Address - Street 2:SUITE 144-120
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2025
Mailing Address - Country:US
Mailing Address - Phone:610-226-2121
Mailing Address - Fax:
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:SUITE 144-120
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2025
Practice Address - Country:US
Practice Address - Phone:610-226-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care