Provider Demographics
NPI:1013058718
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:
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 1:334 3RD ST SW
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2418
Practice Address - Country:US
Practice Address - Phone:605-352-4368
Practice Address - Fax:605-352-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR97322D00000X
SD4083245S0500X
SDR130322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5000090Medicaid
SD5160132Medicaid
SD5160140Medicaid