Provider Demographics
NPI:1104947787
Name:PIONEER HOME OUTREACH, INC.
Entity type:Organization
Organization Name:PIONEER HOME OUTREACH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-781-8585
Mailing Address - Street 1:317 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1732
Mailing Address - Country:US
Mailing Address - Phone:559-781-8585
Mailing Address - Fax:559-791-0183
Practice Address - Street 1:317 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1732
Practice Address - Country:US
Practice Address - Phone:559-781-8585
Practice Address - Fax:559-791-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5442OtherMEDI-CAL