Provider Demographics
NPI:1144575887
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:605-352-4976
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:605-353-1025
Practice Address - Fax:605-353-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10505324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5000090Medicaid