Organization · NPI-2
Avera Queen Of Peace
Medicare Defined Swing Bed Unit · Mitchell, SD
NPI number1780689489
StatusActive
Last updated in NPPESAug 20, 2020
Details
- NPI
- 1780689489
- Entity type
- Organization (NPI-2)
- Legal business name
- Avera Queen Of Peace
- Organization subpart
- Yes
- Enumeration date
- Jun 17, 2005
- Certification date
- Aug 20, 2020
- Last updated
- Aug 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 275N00000X | Medicare Defined Swing Bed Unit | 10552 | SD | Yes |
Other names
- Avera Queen Of Peace Swing Bed Program (Doing Business As)
Practice location
525 N Foster StMitchell, SD 57301-2966
Phone 605-995-2000 · Fax 605-995-2441
Mailing address
525 N Foster StMitchell, SD 57301-2966
Phone 605-995-2000 · Fax 605-995-2441
Authorized official
Douglas Ekeren
President/Ceo
6056688322
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