Healthcare Provider Details

I. General information

NPI: 1558474411
Provider Name (Legal Business Name): AVERA AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S DAKOTA ST STE 1A
MILBANK SD
57252-2809
US

IV. Provider business mailing address

PO BOX 5045
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-4538
  • Fax: 605-432-5412
Mailing address:
  • Phone: 605-322-1872
  • Fax: 605-322-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number48451
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateSD

VIII. Authorized Official

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