Healthcare Provider Details

I. General information

NPI: 1306205406
Provider Name (Legal Business Name): OPIE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 KIERNAN AVE
SALIDA CA
95368-9130
US

IV. Provider business mailing address

2937 VENEMAN AVE STE A105
MODESTO CA
95356-0639
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-3301
  • Fax: 209-579-3311
Mailing address:
  • Phone: 209-579-3301
  • Fax: 209-579-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number500027BP
License Number StateCA

VIII. Authorized Official

Name: NICOLE BLANCHARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-579-3301