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General NPI Number Information
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NPI Number | 1477928752
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Entity Type | Organization
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Legal Business Name | PIONEER CENTER FOR HUMAN SERVICES
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 301 W GRANT HWY
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City | MARENGO
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State | IL
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Zip | 60152-3038
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Country | US
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Telephone | 815-759-7182
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 VETERANS PKWY
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City | MCHENRY
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State | IL
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Zip | 60050-8350
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Country | US
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Telephone | 815-344-1230
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Fax | 815-344-3815
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Authorized Official
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Title or Position | CREDENTIAL BILLING SPECIALIST
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Name | JULIE JOHNSEY
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Credential |
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Telephone | 805-759-7154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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