Organization
PIONEER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHALONIE HERMAN (QIDP SUPERVISOR)
(815) 904-1327
Entity
Organization
Contact information
Practice address
310 CONSTITUTION DRIVE SOWTH WEST, POPLAR GROVE, IL 61065
(815) 800-1196
Mailing address
310 CONSTITUTION DRIVE SOUTH WEST, POPLAR GROVE, IL 61065
(815) 800-1196
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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