Provider Demographics
NPI:1649292863
Name:PLEASANT CARE CORPORATION
Entity type:Organization
Organization Name:PLEASANT CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-9808
Mailing Address - Street 1:2258 FOOTHILL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1476
Mailing Address - Country:US
Mailing Address - Phone:818-248-9808
Mailing Address - Fax:818-541-7072
Practice Address - Street 1:1400 CIRCLE CITY DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1642
Practice Address - Country:US
Practice Address - Phone:951-735-0252
Practice Address - Fax:951-735-0751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLEASANT CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05255IMedicaid
CAZZT05255IMedicaid