Provider Demographics
NPI:1366532376
Name:PIONEER NURSING HOME HEALTH DISTRICT
Entity type:Organization
Organization Name:PIONEER NURSING HOME HEALTH DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUXOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-473-3131
Mailing Address - Street 1:1060 D STREET WEST
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918-1107
Mailing Address - Country:US
Mailing Address - Phone:541-473-3131
Mailing Address - Fax:541-473-2842
Practice Address - Street 1:1060 D STREET WEST
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1107
Practice Address - Country:US
Practice Address - Phone:541-473-3131
Practice Address - Fax:541-473-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1405269801313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR801662Medicaid
OR385273Medicare Oscar/Certification
OR801662Medicaid