Provider Demographics
NPI:1063553527
Name:PIONEER MEMORIAL COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:PIONEER MEMORIAL COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-546-2217
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:MULLEN
Mailing Address - State:NE
Mailing Address - Zip Code:69152-0578
Mailing Address - Country:US
Mailing Address - Phone:308-546-2217
Mailing Address - Fax:308-546-2300
Practice Address - Street 1:206 NW 4TH
Practice Address - Street 2:
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152-0578
Practice Address - Country:US
Practice Address - Phone:308-546-2217
Practice Address - Fax:308-546-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELTCH024313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28-E-175Medicaid