Provider Demographics
NPI:1093902132
Name:OUR HOME INC
Entity Type:Organization
Organization Name:OUR HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBBRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-4368
Mailing Address - Street 1:334 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2418
Mailing Address - Country:US
Mailing Address - Phone:605-352-4368
Mailing Address - Fax:
Practice Address - Street 1:40354 210TH ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-7928
Practice Address - Country:US
Practice Address - Phone:605-352-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR97323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5169110Medicaid