Provider Demographics
NPI:1417067059
Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Entity Type:Organization
Organization Name:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Other - Org Name:PIONEER MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POKORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-326-5161
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-0368
Mailing Address - Country:US
Mailing Address - Phone:605-326-5161
Mailing Address - Fax:605-326-5734
Practice Address - Street 1:315 N. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:VIBORG
Practice Address - State:SD
Practice Address - Zip Code:57070-0368
Practice Address - Country:US
Practice Address - Phone:605-326-5161
Practice Address - Fax:605-326-5734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER MEMORIAL HOSPITAL & HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10698314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160490Medicaid
SD0160490Medicaid