- Enrollment id
- O20140205000782
- Enrollment state
- IA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1720001936
- Multiple npi flag
- N
- Ccn
- 167120
- Associate id
- 8820224280
- Organization name
- AVERA AT HOME
- Doing business as name
- AVERA@HOME
- Incorporation date
- 1987-06-24
- Incorporation state
- SD
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 826 N 8TH ST
- City
- ESTHERVILLE
- State
- IA
- Zip code
- 513341528