Provider Demographics
NPI:1144206020
Name:AVERA ST. LUKES
Entity Type:Organization
Organization Name:AVERA ST. LUKES
Other - Org Name:AVERA EUREKA HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-622-2807
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-0040
Mailing Address - Country:US
Mailing Address - Phone:605-284-2145
Mailing Address - Fax:605-284-2011
Practice Address - Street 1:202 J AVE.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-2225
Practice Address - Country:US
Practice Address - Phone:605-284-2145
Practice Address - Fax:605-284-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10618314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150060Medicaid
SD9572202Medicaid
SD0150060Medicaid