1407840390 NPI number — SIOUX VALLEY REGIONAL HEALTH SERVICES D.B.A HOSPICE OF SIOUX VALLEY LU

Table of content: (NPI 1407840390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407840390 NPI number — SIOUX VALLEY REGIONAL HEALTH SERVICES D.B.A HOSPICE OF SIOUX VALLEY LU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIOUX VALLEY REGIONAL HEALTH SERVICES D.B.A HOSPICE OF SIOUX VALLEY LU
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOSPICE OF SIOUX VALLEY LUVERNE HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407840390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUVERNE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56156-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-283-1805
Provider Business Mailing Address Fax Number:
507-283-1809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUVERNE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56156-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-283-1805
Provider Business Practice Location Address Fax Number:
507-283-1809
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARL
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
507-283-2321

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  327237 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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