Healthcare Provider Details

I. General information

NPI: 1215012059
Provider Name (Legal Business Name): SOUTHWESTERN MINNESOTA OPPORTUNITY COUNCIL, INC CTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 4TH AVE
WORTHINGTON MN
56187-2326
US

IV. Provider business mailing address

909 4TH AVE PO BOX 787
WORTHINGTON MN
56187-2326
US

V. Phone/Fax

Practice location:
  • Phone: 507-376-4195
  • Fax: 507-372-4214
Mailing address:
  • Phone: 507-376-4195
  • Fax: 507-372-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS LORI C KLOOSTER
Title or Position: HEALTH SERVICES DIRECTOR
Credential: RN
Phone: 507-376-4195