1932608916 NPI number — PIONEER HEALING AND RESTORATION SERVICES INC,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932608916 NPI number — PIONEER HEALING AND RESTORATION SERVICES INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER HEALING AND RESTORATION SERVICES INC,
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:
Provider Other Organization Name Type Code:
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:
1932608916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1885 UNIVERSITY AVE W, SUITE 300A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-564-9554
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 UNIVERSITY AVE W STE 300A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-564-9554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOHAMED
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
612-636-3593

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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