Healthcare Provider Details

I. General information

NPI: 1316402589
Provider Name (Legal Business Name): PIONEER RELIEF NURSERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 SW 2ND ST
PENDLETON OR
97801-4160
US

IV. Provider business mailing address

PO BOX 584
PENDLETON OR
97801-0584
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-1017
  • Fax: 541-215-1018
Mailing address:
  • Phone: 541-215-1017
  • Fax: 541-215-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KATE LACEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-215-1017