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SOPHIES MANOR ASSISTED LIVING, INC.
NPI 1114058633
Assisted Living Facility in Pine City, MN

Active since March 08, 2007CLIA 24D1063961 · Waiver
17500 RANCH DR, PINE CITY, MN 55063(320) 629-2064(320) 629-4918 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Sophies Manor Assisted Living, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOPHIES MANOR ASSISTED LIVING, INC. (NPI 1114058633) is a healthcare organization registered as an assisted living facility in Pine City, Minnesota and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through June 2, 2028 and lists Sandra Jo Holt, Administrator, as its authorized official.

NPPES Registry Identity

NPI1114058633
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSOPHIES MANOR ASSISTED LIVING, INC.
Location Address17500 RANCH DRPine City, MN 55063-5502
Mailing Address17500 Ranch DrPine City, MN 55063-5502 · (320) 629-2064 · Fax (320) 629-4918
Phone(320) 629-2064
Fax(320) 629-4918
Organization SubpartNo
Authorized OfficialSandra Jo HoltAdministrator · (320) 629-2064
Enumeration DateMarch 8, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1114058633 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MN · 334231
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
17500 RANCH DR, Pine City, MN 55063
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1063961

Sophie's Manor Assisted Living, Inc · Pine City, MN
Active · expires Jun 2, 2028
CLIA Number24D1063961
Laboratory TypeAssisted Living Facility
Certificate Effective DateJune 3, 2026
Certificate Expiration DateJune 2, 2028
Laboratory DirectorLisa M. Hoadley
Laboratory Phone(320) 629-2064
Laboratory LocationSophie's Manor Assisted Living, Inc17500 Ranch Drive, Pine City, MN 55063
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sophies Manor Assisted Living, Inc.'s NPI number?

The NPI number for Sophies Manor Assisted Living, Inc. is 1114058633. It was assigned to this organization in the NPPES registry on March 8, 2007.

Where is Sophies Manor Assisted Living, Inc. located?

Sophies Manor Assisted Living, Inc. is located at 17500 Ranch Dr, Pine City, MN 55063. The listed phone number is (320) 629-2064.

What is Sophies Manor Assisted Living, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Sophies Manor Assisted Living, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1063961) is associated with this NPI, valid through June 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Sophies Manor Assisted Living, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.