Provider Demographics
NPI:1164429841
Name:PIONEER NURSING, LLC
Entity Type:Organization
Organization Name:PIONEER NURSING, LLC
Other - Org Name:PIONEER SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:1500 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:MARCELINE
Mailing Address - State:MO
Mailing Address - Zip Code:64658
Mailing Address - Country:US
Mailing Address - Phone:660-376-2001
Mailing Address - Fax:660-376-3473
Practice Address - Street 1:1500 S KANSAS AVE
Practice Address - Street 2:
Practice Address - City:MARCELINE
Practice Address - State:MO
Practice Address - Zip Code:64658
Practice Address - Country:US
Practice Address - Phone:660-376-2001
Practice Address - Fax:660-376-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029532314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265169Medicare Oscar/Certification