Healthcare Provider Details

I. General information

NPI: 1689405359
Provider Name (Legal Business Name): PIONEER DAY HAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N A W GRIMES BLVD STE 700
ROUND ROCK TX
78665-2745
US

IV. Provider business mailing address

2200 N A W GRIMES BLVD STE 700
ROUND ROCK TX
78665-2745
US

V. Phone/Fax

Practice location:
  • Phone: 512-367-9049
  • Fax: 512-727-9209
Mailing address:
  • Phone: 512-367-9049
  • Fax: 512-727-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MONTGOMERY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 512-367-9049