Provider Demographics
NPI:1649063629
Name:PLEASANTVILLE ASSISTED LIVING
Entity type:Organization
Organization Name:PLEASANTVILLE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-759-6059
Mailing Address - Street 1:4125 N 70TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1163
Mailing Address - Country:US
Mailing Address - Phone:414-616-1290
Mailing Address - Fax:414-616-1749
Practice Address - Street 1:4125 N 70TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1163
Practice Address - Country:US
Practice Address - Phone:414-616-1290
Practice Address - Fax:414-616-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility