Provider Demographics
NPI:1982698296
Name:PLEASANT MANOR CARE CENTER
Entity Type:Organization
Organization Name:PLEASANT MANOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-385-8095
Mailing Address - Street 1:413 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-1609
Mailing Address - Country:US
Mailing Address - Phone:319-385-8095
Mailing Address - Fax:319-385-3372
Practice Address - Street 1:413 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1609
Practice Address - Country:US
Practice Address - Phone:319-385-8095
Practice Address - Fax:319-385-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN0237313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16E207Medicaid