Pioneer Concepts INC
Intermediate Care Facility, Intellectual Disabilities in Sauk Village, IL. Organization (NPI-2).
NPI number1760655989
StatusActive
Last updated in NPPESApr 20, 2008
Details
- NPI
- 1760655989
- Entity type
- Organization (NPI-2)
- Legal business name
- Pioneer Concepts INC
- Organization subpart
- Yes
- Enumeration date
- Apr 9, 2008
- Last updated
- Apr 20, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | 48025 | IL | Yes |
Other names
- Prairie House (Doing Business As)
Practice location
1770 Sauk TrailSauk Village, IL 60411-4956
Phone 708-757-6729 · Fax 708-757-6974
Mailing address
285 South Farnham StreetGalesburg, IL 61401-5323
Phone 309-343-1550 · Fax 309-343-6318
Authorized official
Ronald J Wilson
Authorized Agent
3093431550
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