NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Brady Assisted Living

  • Assisted Living Facility
  • Mitchell, SD
National Provider Identifier
1497750384
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
41972 Issued in SD
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Brady Assisted Living
Practice address
1414 W Cedar Ave
Mitchell, SD 57301-3868
Phone
(605) 996-7702
NPI assigned
Jun 16, 2005
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
AVERA QUEEN OF PEACEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Authorized official

Name
Douglas Ekeren
Title
President/Ceo
Phone
(605) 668-8322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 41972 SD Primary

Addresses

Primary practice location

1414 W Cedar Ave
Mitchell, SD 57301-3868

Mailing address

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2000

Other identifiers 1

IdentifierTypeStateIssuer
9571240MedicaidSD

Other names 1

  • Avera Brady Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Queen of Peace Hosp29 organizations share this tax ID, including this one
Part of
Queen of Peace Hosp

Other organizations with this tax ID 28

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

View all 28

Locations

1414 W Cedar Ave
Mitchell, SD 57301
Phone (605) 996-7702

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1497750384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W CEDAR AVE",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573013868",
            "telephone_number": "605-996-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA QUEEN OF PEACE",
        "enumeration_date": "2005-06-16",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "EKEREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-668-8322"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "41972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9571240",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Brady Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Brady Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.