Provider Demographics
NPI:1023170214
Name:PIONEER HEALTH, INC.
Entity type:Organization
Organization Name:PIONEER HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KASUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-694-7071
Mailing Address - Street 1:5665 S REDWOOD RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5322
Mailing Address - Country:US
Mailing Address - Phone:801-265-0669
Mailing Address - Fax:801-265-0811
Practice Address - Street 1:5665 S REDWOOD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5322
Practice Address - Country:US
Practice Address - Phone:801-265-0669
Practice Address - Fax:801-265-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid