Provider Demographics
NPI:1316155237
Name:OPPORTUNITY MANOR INC
Entity type:Organization
Organization Name:OPPORTUNITY MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-240-1900
Mailing Address - Street 1:1908 KRUCHTEN CT S
Mailing Address - Street 2:PO BOX 280
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4645
Mailing Address - Country:US
Mailing Address - Phone:320-240-1900
Mailing Address - Fax:320-240-8527
Practice Address - Street 1:1311 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-1913
Practice Address - Country:US
Practice Address - Phone:320-255-0135
Practice Address - Fax:320-240-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801815-3-RS310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness