Provider Demographics
NPI:1639278187
Name:PREFERRED HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:PREFERRED HOME HEALTH AGENCY
Other - Org Name:PREFERRED HOME HEALTH, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-375-3738
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-0273
Mailing Address - Country:US
Mailing Address - Phone:605-375-3738
Mailing Address - Fax:605-375-3739
Practice Address - Street 1:306 W. THIRD STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720-0273
Practice Address - Country:US
Practice Address - Phone:605-375-3738
Practice Address - Fax:605-375-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD437052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5195030Medicaid
SD0171350Medicaid
SD9550200Medicaid
SD437052Medicare ID - Type UnspecifiedMEDICARE PROVIDER #