Provider Demographics
NPI:1821042920
Name:AVERA TYLER
Entity Type:Organization
Organization Name:AVERA TYLER
Other - Org Name:AVERA SUNRISE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STREIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-9160
Mailing Address - Street 1:240 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-1166
Mailing Address - Country:US
Mailing Address - Phone:507-247-5521
Mailing Address - Fax:507-247-5972
Practice Address - Street 1:240 WILLOW ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178-1166
Practice Address - Country:US
Practice Address - Phone:507-247-5521
Practice Address - Fax:507-247-5972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA TYLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376918314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1889NALOtherBLUE CROSS
MN599245100Medicaid
MN1889NALOtherBLUE CROSS