Healthcare Provider Details

I. General information

NPI: 1982824439
Provider Name (Legal Business Name): AVERA AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/08/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUMMIT ST
YANKTON SD
57078-3855
US

IV. Provider business mailing address

2400 S MINNESOTAVE AVE
SIOUX FALLS SD
57105
US

V. Phone/Fax

Practice location:
  • Phone: 605-668-8103
  • Fax: 605-668-8097
Mailing address:
  • Phone: 605-322-1872
  • Fax: 605-322-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

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