- Enrollment id
- O20140206001135
- Enrollment state
- IA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1952405516
- Multiple npi flag
- N
- Ccn
- 161501
- 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