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Organization

PIONEER HOME LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IFEOMA NWUFOR DNP (ADMINISTRATOR)
(424) 653-7426
Entity
Organization

Contact information

Practice address
1204 W GARDENA BLVD STE B, GARDENA, CA 90247-5923
(424) 653-7426
Mailing address
17817 HAZELWOOD CT, CARSON, CA 90746-7481
(424) 653-7426

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
06/24/2020
Last updated
10/18/2021
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