Provider Demographics
NPI:1619010642
Name:PLEASANT VALLEY HOME MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:PLEASANT VALLEY HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-4340
Mailing Address - Street 1:300 CLAY LICK RD
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9224
Mailing Address - Country:US
Mailing Address - Phone:304-372-5393
Mailing Address - Fax:304-372-5399
Practice Address - Street 1:300 CLAY LICK RD
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9224
Practice Address - Country:US
Practice Address - Phone:304-372-5393
Practice Address - Fax:304-372-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0148456000Medicaid
OH0606866Medicaid
WV0148456000Medicaid