Provider Demographics
NPI:1568505493
Name:SOUTHWESTERN MINNESOTA OPPORTUNITY COUNCIL, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN MINNESOTA OPPORTUNITY COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:507-376-4195
Mailing Address - Street 1:909 4TH AVE
Mailing Address - Street 2:PO BOX 787
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2326
Mailing Address - Country:US
Mailing Address - Phone:507-376-4195
Mailing Address - Fax:507-372-4214
Practice Address - Street 1:909 4TH AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2326
Practice Address - Country:US
Practice Address - Phone:504-376-4195
Practice Address - Fax:507-372-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty