Provider Demographics
NPI:1982607271
Name:PLEASANT MANOR, INC.
Entity Type:Organization
Organization Name:PLEASANT MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:507-334-2036
Mailing Address - Street 1:27 BRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6411
Mailing Address - Country:US
Mailing Address - Phone:507-334-2036
Mailing Address - Fax:507-334-3558
Practice Address - Street 1:27 BRAND AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6411
Practice Address - Country:US
Practice Address - Phone:507-334-2036
Practice Address - Fax:507-334-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326599314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0025681Medicaid
MN270543500OtherDHS PROVIDER NUMBER
MN270543500OtherDHS PROVIDER NUMBER