# PLEASANTVILLE HOME CARE AGENCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043874985
- **Authorized official:** KEITH MARTIN JR. (PRESIDENT)
- **Authorized official phone:** (414) 759-6059

## Contact information

- **Practice address:** 4200 N HOLTON ST STE 100, MILWAUKEE, WI 53212-1064
- **Practice address phone:** (414) 909-0296
- **Practice address fax:** (414) 962-4003
- **Mailing address:** 4200 N HOLTON ST STE 100, MILWAUKEE, WI 53212-1064
- **Mailing address phone:** (414) 909-0296
- **Mailing address fax:** (414) 962-4003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/25/2019
- **Last updated:** 04/25/2019