MEDICARE: OPPORTUNITY LIVING

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	IMR608	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164590642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPPORTUNITY LIVING

Provider Business Mailing Address
First Line	:	1890 E MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-7706
Country	:	US
Telephone Number	:	712-464-8961
Fax Number	:	712-464-3320

Provider Business Practice Location Address
First Line	:	1890 E MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-7706
Country	:	US
Telephone Number	:	712-464-8961
Fax Number	:	712-464-3320

Authorized Official
Title or Position	:	FINANCIAL OFFICER
Name	:	JILL WESTCOTT
Credential	:
Telephone Number	:	712-464-8961

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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Directions to “OPPORTUNITY LIVING ” Practice Location

Language	Start Address	Practice Location

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