Healthcare Provider Details

I. General information

NPI: 1811399827
Provider Name (Legal Business Name): PIONEER HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 SAINT JOAN LN
SAINT CHARLES MO
63301-4451
US

IV. Provider business mailing address

PO BOX 1876
SAINT CHARLES MO
63302-1876
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-0006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number057.004111
License Number StateMO

VIII. Authorized Official

Name: JILL DEAN
Title or Position: COTA
Credential:
Phone: 636-634-0006