Provider Demographics
NPI:1336651405
Name:PIONEER CARE LLC
Entity Type:Organization
Organization Name:PIONEER CARE LLC
Other - Org Name:PIONEER ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-986-3859
Mailing Address - Street 1:PO BOX 46104
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-0104
Mailing Address - Country:US
Mailing Address - Phone:612-200-0732
Mailing Address - Fax:612-524-5494
Practice Address - Street 1:8751 PRESERVE BLVD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5301
Practice Address - Country:US
Practice Address - Phone:612-986-3859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility