Provider Demographics
NPI:1235577115
Name:PIONEER GUEST HOME II, INC
Entity Type:Organization
Organization Name:PIONEER GUEST HOME II, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:RODDEY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:541-263-0897
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-0326
Mailing Address - Country:US
Mailing Address - Phone:541-426-4222
Mailing Address - Fax:541-426-6550
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1381
Practice Address - Country:US
Practice Address - Phone:541-426-4222
Practice Address - Fax:541-426-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR300024320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness