Provider Demographics
NPI:1669448254
Name:PIONEER HOME INCORPORATED
Entity type:Organization
Organization Name:PIONEER HOME INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:A/R SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KACER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-1540
Mailing Address - Street 1:1006 S SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-3518
Mailing Address - Country:US
Mailing Address - Phone:218-739-7700
Mailing Address - Fax:218-739-7707
Practice Address - Street 1:1131 S MABELLE AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3723
Practice Address - Country:US
Practice Address - Phone:218-998-1500
Practice Address - Fax:218-998-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8090221ADC261Q00000X
MNFLB001784712556310400000X
MN1064141-1-ADC310400000X
MN328217314000000X
333300000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7100383OtherMEDICA PROVIDER NUMBER
MN707342900Medicaid
MN9668PIOtherBCBS PROVIDER NUMBER
MN245463Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER