Provider Demographics
NPI:1740541861
Name:LAURENS SENIOR PIONEERS INC
Entity type:Organization
Organization Name:LAURENS SENIOR PIONEERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HERSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-845-4915
Mailing Address - Street 1:304 E VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:IA
Mailing Address - Zip Code:50554-1555
Mailing Address - Country:US
Mailing Address - Phone:712-845-4915
Mailing Address - Fax:712-845-2502
Practice Address - Street 1:304 E VETERANS RD
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:IA
Practice Address - Zip Code:50554-1555
Practice Address - Country:US
Practice Address - Phone:712-845-4915
Practice Address - Fax:712-845-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA760020314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD165219Medicare Oscar/Certification