Healthcare Provider Details

I. General information

NPI: 1104332337
Provider Name (Legal Business Name): OPPORTUNITY FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E EAGEL DR
NEW TOWN ND
58763
US

IV. Provider business mailing address

PO BOX 1627
WILLISTON ND
58802-1627
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-8593
  • Fax: 701-572-8871
Mailing address:
  • Phone: 701-774-8593
  • Fax: 701-572-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNEWTOWN
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: ANDREA J PETERSON
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 701-774-8593