Provider Demographics
NPI:1477928752
Name:PIONEER CENTER FOR HUMAN SERVICES
Entity Type:Organization
Organization Name:PIONEER CENTER FOR HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-759-7154
Mailing Address - Street 1:4100 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8350
Mailing Address - Country:US
Mailing Address - Phone:815-344-1230
Mailing Address - Fax:815-344-3815
Practice Address - Street 1:301 W GRANT HWY
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3038
Practice Address - Country:US
Practice Address - Phone:815-759-7182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities