Healthcare Provider Details

I. General information

NPI: 1912150608
Provider Name (Legal Business Name): AT HOME NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S CLEVELAND AVE
PIERRE SD
57501-4456
US

IV. Provider business mailing address

1102 S CLEVELAND AVE
PIERRE SD
57501-4456
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-2930
  • Fax: 605-224-0548
Mailing address:
  • Phone: 605-224-2930
  • Fax: 605-224-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health 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: MICHELLE MARY DVORAK
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 605-224-2930