Provider Demographics
NPI:1285626671
Name:PIONEER MEMORIAL CARE CENTER
Entity Type:Organization
Organization Name:PIONEER MEMORIAL CARE CENTER
Other - Org Name:THE COUNTRY PLACE , CROSSROADS APARTMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-687-2365
Mailing Address - Street 1:23028 347TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ERSKINE
Mailing Address - State:MN
Mailing Address - Zip Code:56535-9466
Mailing Address - Country:US
Mailing Address - Phone:218-687-2365
Mailing Address - Fax:218-687-2047
Practice Address - Street 1:23028 347TH ST SE
Practice Address - Street 2:
Practice Address - City:ERSKINE
Practice Address - State:MN
Practice Address - Zip Code:56535-9466
Practice Address - Country:US
Practice Address - Phone:218-687-2365
Practice Address - Fax:218-687-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328447314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN358342200Medicaid
MN328447OtherMN DEPT OF HEALTH LICENSE
MN24-5301Medicare ID - Type UnspecifiedMEDICARE