1679698658 NPI number — OPPORTUNITIES UNLIMITED, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679698658 NPI number — OPPORTUNITIES UNLIMITED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPPORTUNITIES UNLIMITED, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679698658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 SNAKE RIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-743-1563
Provider Business Mailing Address Fax Number:
208-798-0340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 W 3RD ST
Provider Second Line Business Practice Location Address:
BUILDING 1 HWY 12
Provider Business Practice Location Address City Name:
KAMIAH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-935-0847
Provider Business Practice Location Address Fax Number:
208-935-0852
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARSONS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEDICAID BILLING SPECIALIST
Authorized Official Telephone Number:
208-743-1563

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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