- Enrollment id
- O20140522001096
- Enrollment state
- MN
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1033535547
- Multiple npi flag
- N
- Ccn
- 248144
- Associate id
- 5799695227
- Organization name
- AVERA MARSHALL
- Doing business as name
- AVERA@HOME SOUTHWEST MINNESOTA
- Incorporation date
- 1944-12-26
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 300 S BRUCE ST
- City
- MARSHALL
- State
- MN
- Zip code
- 562581934