1669448254 NPI number — PIONEER HOME INCORPORATED

Table of content: (NPI 1669448254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669448254 NPI number — PIONEER HOME INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER HOME INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PIONEER RETIREMENT COMMUNITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669448254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 S SHERIDAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-739-7700
Provider Business Mailing Address Fax Number:
218-739-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1131 S MABELLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-998-1500
Provider Business Practice Location Address Fax Number:
218-998-1580
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KACER
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
A/R SPECIALIST
Authorized Official Telephone Number:
218-998-1540

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  8090221ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: FLB001784712556 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 1064141-1-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 328217 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100383 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 707342900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9668PI . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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