NPIMap

Organization Active NPI

Country Manor Campus LLC

  • Assisted Living Facility
  • Sartell, MN
National Provider Identifier
1912896135
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
COUNTRY MANOR CAMPUS LLC
Practice address
520 1St St NE
Sartell, MN 56377-1274
Phone
(320) 253-1920
NPI assigned
Jul 1, 2025
Organization subpart
Yes
Parent organization
COUNTRY MANOR CAMPUS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin G. Harguth
Title
Cfo
Phone
(320) 258-8983

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

520 1St St NE
Sartell, MN 56377-1274

Mailing address

520 1St St NE
Sartell, MN 56377-1274
Phone (320) 253-1920

Other practice location 1

504 1st St NE
Sartell, MN 56377-1273
Phone (320) 253-1920

Other names 1

  • The Country Villa Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Country Manor Campus LLC9 organizations share this tax ID, including this one
Part of
Country Manor Campus LLC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1912896135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 1ST ST NE",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-253-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 1ST ST NE",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-253-1920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 1st St NE",
            "address_purpose": "LOCATION",
            "city": "Sartell",
            "state": "MN",
            "postal_code": "563771273",
            "country_code": "US",
            "telephone_number": "320-253-1920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COUNTRY MANOR CAMPUS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTRY MANOR CAMPUS LLC",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "HARGUTH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-258-8983"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Country Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.