Organization
AVERA ST MARYS
Active
Other names
Avera Maryhouse Long Term Care
Organization subpart
No
Provider details
NPI number
Authorized official
MIKEL HOLLAND (CEO/PRESIDENT)
(605) 224-3144
Entity
Organization
Contact information
Practice address
801 E SIOUX AVE, PIERRE, SD 57501-3323
(605) 224-3100
(605) 224-8339
Mailing address
PO BOX 5045, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10662
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150360
—
SD
01
—
85034
BCBS
SD
Enumeration date
03/30/2009
Last updated
07/15/2022
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