NPIMap

Organization Active NPI

Avera St Luke's

Doing business as Avera Nano Nagle Village

  • Assisted Living Facility
  • Aberdeen, SD
National Provider Identifier
1124163225
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
41969 Issued in SD
Legal business name
AVERA ST LUKE'S
Doing business as
Avera Nano Nagle Village
Practice address
1002 N Jay St
Aberdeen, SD 57401-2439
Phone
(605) 622-5847
Fax
(605) 622-5255
NPI assigned
Feb 20, 2007
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tess Moeller
Title
VP
Phone
(605) 622-2870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 41969 SD Primary

Addresses

Primary practice location

1002 N Jay St
Aberdeen, SD 57401-2439

Mailing address

1020 N Jay St
Aberdeen, SD 57401-2480
Phone (605) 622-5847

Other identifiers 1

IdentifierTypeStateIssuer
9572350MedicaidSD

Other names 1

  • Avera Nano Nagle Village Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amg Radiology Aberdeen25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1124163225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 N JAY ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574012480",
            "telephone_number": "605-622-5847",
            "fax_number": "605-622-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N JAY ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574012439",
            "telephone_number": "605-622-5847",
            "fax_number": "605-622-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST LUKE'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "MOELLER",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "605-622-2870"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "41969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9572350",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Nano Nagle Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Nano Nagle Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aberdeen, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.