Provider Demographics
NPI:1699133579
Name:AVERA ST. LUKES
Entity type:Organization
Organization Name:AVERA ST. LUKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BJERKNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-622-5125
Mailing Address - Street 1:PO BOX 860674
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0605
Mailing Address - Country:US
Mailing Address - Phone:605-622-5800
Mailing Address - Fax:
Practice Address - Street 1:1206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7071
Practice Address - Country:US
Practice Address - Phone:605-622-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WORTHMORE ADDICTION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder