Organization Name: | AVERA AT HOME |
NPI Number: | 1467474239 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SANDRA D DIELEMAN (CEO/PRESIDENT) |
Mailing Address: | 4509 Prince Of Peace Pl Hospice Unit Sioux Falls |
State: | SD US |
Postal Code: | 571035830 |
Phone Number: | 6053225490 |
Fax Number: | 6053223179 |
NPI Enumeration Date: | 07/24/2006 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 10563 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |