Healthcare Provider Details

I. General information

NPI: 1477928752
Provider Name (Legal Business Name): PIONEER CENTER FOR HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W GRANT HWY
MARENGO IL
60152-3038
US

IV. Provider business mailing address

4100 VETERANS PKWY
MCHENRY IL
60050-8350
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-7182
  • Fax:
Mailing address:
  • Phone: 815-344-1230
  • Fax: 815-344-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JULIE JOHNSEY
Title or Position: CREDENTIAL BILLING SPECIALIST
Credential:
Phone: 805-759-7154