Provider Demographics
NPI:1922010842
Name:PLEASANT VIEW CONVALESCENT HOSPITAL, INC.
Entity type:Organization
Organization Name:PLEASANT VIEW CONVALESCENT HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EASTERDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-899-7999
Mailing Address - Street 1:22590 VOSS AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2627
Mailing Address - Country:US
Mailing Address - Phone:408-253-9034
Mailing Address - Fax:408-255-9148
Practice Address - Street 1:22590 VOSS AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2627
Practice Address - Country:US
Practice Address - Phone:408-253-9034
Practice Address - Fax:408-255-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
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
CAZZR05407HMedicaid
CA055407Medicare ID - Type UnspecifiedBILLING NUMBER