Provider Demographics
NPI:1437108180
Name:AVERA AT HOME
Entity Type:Organization
Organization Name:AVERA AT HOME
Other - Org Name:AVERA@HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIELEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-322-3984
Mailing Address - Street 1:5116 S SOLBERG AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2219
Mailing Address - Country:US
Mailing Address - Phone:605-322-4597
Mailing Address - Fax:605-322-3380
Practice Address - Street 1:318 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1238
Practice Address - Country:US
Practice Address - Phone:605-853-0365
Practice Address - Fax:605-853-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD437020Medicare Oscar/Certification