Healthcare Provider Details

I. General information

NPI: 1891738365
Provider Name (Legal Business Name): AVERA HOLY FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 N 8TH ST
ESTHERVILLE IA
51334-1528
US

IV. Provider business mailing address

826 N 8TH ST
ESTHERVILLE IA
51334-1528
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-2631
  • Fax: 712-362-2636
Mailing address:
  • Phone: 712-362-2631
  • Fax: 712-362-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number320014H
License Number StateIA

VIII. Authorized Official

Name: DEB HERZBERG
Title or Position: CEO
Credential:
Phone: 712-362-6160