Healthcare Provider Details

I. General information

NPI: 1972644557
Provider Name (Legal Business Name): OPPORTUNITIES UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 35TH ST
SIOUX CITY IA
51104-1558
US

IV. Provider business mailing address

3439 GLEN OAKS BLVD
SIOUX CITY IA
51104-1761
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-8295
  • Fax: 712-277-8602
Mailing address:
  • Phone: 712-277-8295
  • Fax: 712-277-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number0881219
License Number StateIA

VIII. Authorized Official

Name: TREY WEAVER
Title or Position: FINANCE MANAGER
Credential:
Phone: 712-277-8295