MEDICARE: OPPORTUNITIES NORTH, LLC

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	261QA0600X	Adult Day Care Clinic/Center		NY

General Provider Information

NPI Number	:	1689866824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPPORTUNITIES NORTH, LLC

Provider Business Mailing Address
First Line	:	444 DIXON RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1959
Country	:	US
Telephone Number	:	518-668-4353
Fax Number	:	518-668-2241

Provider Business Practice Location Address
First Line	:	2741 STATE ROUTE 9
Second Line	:
City	:	LAKE GEORGE
State	:	NY
Zip	:	12845-6304
Country	:	US
Telephone Number	:	518-668-4353
Fax Number	:	518-668-2241

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JESSYCA A TOKOS-DARRAH
Credential	:
Telephone Number	:	518-668-4353

Provider Enumeration Date	:	08/12/2007
Last Update Date	:	08/12/2007

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