Provider Demographics
NPI:1477671444
Name:PIONEER HOME LLC
Entity Type:Organization
Organization Name:PIONEER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-355-6212
Mailing Address - Street 1:110 WEST RAILROAD AVE.
Mailing Address - Street 2:BOX 48
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-0048
Mailing Address - Country:US
Mailing Address - Phone:620-355-6212
Mailing Address - Fax:620-355-8043
Practice Address - Street 1:110 W. RAILROAD AVE
Practice Address - Street 2:BOX 48
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-0048
Practice Address - Country:US
Practice Address - Phone:162-035-5621
Practice Address - Fax:620-355-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB047001177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty