Provider Demographics
NPI:1114058633
Name:SOPHIES MANOR ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:SOPHIES MANOR ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-629-2064
Mailing Address - Street 1:17500 RANCH DR
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-5502
Mailing Address - Country:US
Mailing Address - Phone:320-629-2064
Mailing Address - Fax:320-629-4918
Practice Address - Street 1:17500 RANCH DR
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-5502
Practice Address - Country:US
Practice Address - Phone:320-629-2064
Practice Address - Fax:320-629-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334231310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility