Provider Demographics
NPI:1689064586
Name:PIONEER HOME CARE
Entity Type:Organization
Organization Name:PIONEER HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELVALYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-885-2533
Mailing Address - Street 1:100 EINSTEIN LOOP
Mailing Address - Street 2:ALT 5E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4947
Mailing Address - Country:US
Mailing Address - Phone:347-885-2533
Mailing Address - Fax:
Practice Address - Street 1:100 EINSTEIN LOOP
Practice Address - Street 2:APT5E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:347-885-2533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290866-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6850OtherMEDICAID
NY730030976Medicaid
NY6850Medicaid