- Enrollment id
- O20140513001478
- Enrollment state
- MN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1952727463
- Multiple npi flag
- N
- Ccn
- 241598
- 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
- OTHER
- Organization other type text
- NON-PROFIT CORPERATION
- Proprietary nonprofit
- N
- Address line 1
- 300 S BRUCE ST
- City
- MARSHALL
- State
- MN
- Zip code
- 562581934