1609305069 NPI number — OPPORTUNITY MINISTRIES, INC.

Table of content: (NPI 1609305069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609305069 NPI number — OPPORTUNITY MINISTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPPORTUNITY MINISTRIES, 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:
6
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:
1609305069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4513 MOUNTAIN RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-5331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-255-4342
Provider Business Mailing Address Fax Number:
410-504-6182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4513 MOUNTAIN RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21122-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-255-4342
Provider Business Practice Location Address Fax Number:
410-504-6182
Provider Enumeration Date:
06/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
410-255-4342

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 819664 . This is a "BEACON- NON MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com