Provider Demographics
NPI:1861664013
Name:PIONEER GARDENS SENIOR HOUSING LP
Entity Type:Organization
Organization Name:PIONEER GARDENS SENIOR HOUSING LP
Other - Org Name:PIONEER GARDENS SUPPORTIVE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:773-420-4101
Mailing Address - Street 1:3800 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1785
Mailing Address - Country:US
Mailing Address - Phone:773-420-4100
Mailing Address - Fax:773-536-0720
Practice Address - Street 1:3800 S KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-1785
Practice Address - Country:US
Practice Address - Phone:773-420-4100
Practice Address - Fax:773-536-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282E00000X
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32001233001Medicaid