AVERA MCKENNAN
Assisted Living Facility
Sioux Falls, South Dakota
Provider NPI: 1508854340
Organization Information:Organization Name: AVERA MCKENNAN
Practice Location:
4513 S PRINCE OF PEACE PL SIOUX FALLS, SD 57103 US
Tel: 605-322-5600 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
4513 S PRINCE OF PEACE PL SIOUX FALLS, SD 57103 US
Tel: 605-322-5600 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 310400000X | Nursing & Custodial Care Facilities Assisted Living Facility | SD | 10722 |
Y | 314000000X | Nursing & Custodial Care Facilities Skilled Nursing Facility | SD | 10722 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
0151172 | SD | 05 | |
BLUE CROSS OF SD | 85066 | SD | 01 |
9572080 | SD | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin