MEDICARE: OPPORTUNITY FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1114123106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPPORTUNITY FOUNDATION INC

Provider Business Mailing Address
First Line	:	612 EAST BROADWAY
Second Line	:	PO BOX 1627
City	:	WILLISTON
State	:	ND
Zip	:	58801-1627
Country	:	US
Telephone Number	:	701-774-8593
Fax Number	:	701-572-8871

Provider Business Practice Location Address
First Line	:	612 EAST BROADWAY
Second Line	:
City	:	WILLISTON
State	:	ND
Zip	:	58801-1627
Country	:	US
Telephone Number	:	701-774-8593
Fax Number	:	701-572-8871

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	ANDREA J PETERSON
Credential	:
Telephone Number	:	701-774-8593

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/22/2020

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Directions to “OPPORTUNITY FOUNDATION INC ” Practice Location

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