Healthcare Provider Details

I. General information

NPI: 1346660693
Provider Name (Legal Business Name): AVERA AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARK AVE
GREGORY SD
57533-1302
US

IV. Provider business mailing address

400 PARK AVE
GREGORY SD
57533-1302
US

V. Phone/Fax

Practice location:
  • Phone: 605-835-5263
  • Fax: 605-835-8406
Mailing address:
  • Phone: 605-835-5263
  • Fax: 605-835-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANDRA D DIELEMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 605-322-3984