Provider Demographics
NPI:1891311833
Name:PIONEER HOME LLC
Entity Type:Organization
Organization Name:PIONEER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWUFOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:424-653-7426
Mailing Address - Street 1:17817 HAZELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7481
Mailing Address - Country:US
Mailing Address - Phone:424-653-7426
Mailing Address - Fax:
Practice Address - Street 1:1204 W GARDENA BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5923
Practice Address - Country:US
Practice Address - Phone:424-653-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251E00000XAgenciesHome Health