Provider Demographics
NPI:1205507902
Name:AVERA HOME MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:AVERA HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIELEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-322-3984
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-1872
Mailing Address - Fax:605-322-1892
Practice Address - Street 1:1216 RYANS RD STE 4
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1780
Practice Address - Country:US
Practice Address - Phone:507-372-6673
Practice Address - Fax:507-372-6674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA HOME MEDICAL EQUIPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies