Organization
UNITED PIONEER HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY ARCHIE ANDRESS (NURSING HOME ADMINISTRATOR)
(715) 472-2164
Entity
Organization
Contact information
Practice address
623 S. SECOND ST., LUCK, WI 54853-9066
(715) 472-2164
(715) 472-2180
Mailing address
623 S. SECOND ST., LUCK, WI 54853-9066
(715) 472-2164
(715) 472-2180
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0450
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20157300
—
WI
Enumeration date
09/29/2005
Last updated
11/27/2019
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