Provider Demographics
NPI:1497065478
Name:PIONEER HEALTH ALLIANCE INC
Entity Type:Organization
Organization Name:PIONEER HEALTH ALLIANCE INC
Other - Org Name:WELLNESS ON WHEELS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-516-3972
Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-508-1125
Mailing Address - Fax:352-674-4386
Practice Address - Street 1:1580 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6827
Practice Address - Country:US
Practice Address - Phone:352-508-1125
Practice Address - Fax:352-674-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010139401Medicaid
FLEY818AOtherMEDICARE PTAN