Provider Demographics
NPI:1346425543
Name:OPEN HARBORS INC.
Entity Type:Organization
Organization Name:OPEN HARBORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGERY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VETSCH-PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-389-5412
Mailing Address - Street 1:28347 112TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4307
Mailing Address - Country:US
Mailing Address - Phone:763-389-5412
Mailing Address - Fax:
Practice Address - Street 1:28347 112TH ST NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4307
Practice Address - Country:US
Practice Address - Phone:763-389-5412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10413503AFC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGMedicaid