AVERA QUEEN OF PEACE NPI 1497750384

NPI Information

NPI: 1497750384
Provider Name: AVERA QUEEN OF PEACE

Doing Business As: AVERA BRADY ASSISTED LIVING

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
1414 W CEDAR AVE
MITCHELL, SD
ZIP 57301
Phone: (605) 996-7702
Get Directions

AVERA QUEEN OF PEACE is an assisted living facility in Mitchell, SD. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. AVERA QUEEN OF PEACE NPI is 1497750384. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera Brady Assisted Living.

The provider's business location address is:

1414 W CEDAR AVE
MITCHELL, SD
ZIP 57301-868
Phone: (605) 996-7702

The provider's authorized official is Douglas Ekeren .
The authorized official title is President/ceo and has the following contact phone number (605) 668-8322.

The enumeration date for this NPI number is 6/16/2005 and was last updated on 8/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		41972	SOUTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9571240	MEDICAID	SOUTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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