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General NPI Number Information
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NPI Number | 1811399827
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Entity Type | Organization
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Legal Business Name | PIONEER HEALTHCARE SERVICES
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 3218 SAINT JOAN LN
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4451
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Country | US
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Telephone | 636-634-0006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1876
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City | SAINT CHARLES
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State | MO
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Zip | 63302-1876
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | JILL DEAN
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Credential |
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Telephone | 636-634-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 057.004111
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License Number State | MO
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