Provider Demographics
NPI:1467512137
Name:PIONEER RIDGE NURSING FACILITY OPERATIONS, LLC
Entity Type:Organization
Organization Name:PIONEER RIDGE NURSING FACILITY OPERATIONS, LLC
Other - Org Name:PIONEER RIDGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-272-1535
Mailing Address - Street 1:3024 SW WANAMAKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4498
Mailing Address - Country:US
Mailing Address - Phone:785-228-7913
Mailing Address - Fax:785-438-5513
Practice Address - Street 1:4851 HARVARD ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-749-2000
Practice Address - Fax:785-344-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100112080A313M00000X
KS175445314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100112080AMedicaid
KS100112080AMedicaid