Healthcare Provider Details

I. General information

NPI: 1235897760
Provider Name (Legal Business Name): NORTH PLATTE OPPORTUNITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRYAN AVE
NORTH PLATTE NE
69101-4370
US

IV. Provider business mailing address

PO BOX 729
NORTH PLATTE NE
69103-0729
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3965
  • Fax: 308-534-4311
Mailing address:
  • Phone: 308-532-3965
  • Fax: 308-534-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. TINA LYNN GASTINEAU
Title or Position: AGENCY ADMINISTRATOR
Credential:
Phone: 308-532-3965