Avera Queen of Peace
Organization Active NPI Assisted Living Facility · Mitchell, SD
NPI 1497750384 · NPPES record last updated Aug 20, 2020
Key facts
- NPI
- 1497750384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 41972 (SD)
- Legal business name
- AVERA QUEEN OF PEACE
- Practice address
- 1414 W Cedar Ave
Mitchell, SD 57301-3868 - Phone
- (605) 996-7702
- NPI assigned
- Jun 16, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- AVERA QUEEN OF PEACE
Authorized official
- Name
- Douglas Ekeren
- Title
- President/Ceo
- Phone
- (605) 668-8322
Corporate family (same tax ID) 28
National Provider Directory
- Tax ID family
- ER Phy
- Part of
- ER Phy
Locations
1414 W Cedar Ave
Mitchell, SD 57301
Phone (605) 996-7702
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 41972 | SD | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9571240 | Medicaid | SD |
Other names
- Avera Brady Assisted Living
Other providers in Mitchell, SD
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
All providers in Mitchell, SD · Assisted Living Facility in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.