Provider Demographics
NPI:1174005714
Name:RESIDENTIAL OPPORTUNITIES, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL OPPORTUNITIES, INC.
Other - Org Name:ELAINE AVENUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT AND COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHASHEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:BASH
Authorized Official - Phone:269-250-8228
Mailing Address - Street 1:1100 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2664
Mailing Address - Country:US
Mailing Address - Phone:269-250-8228
Mailing Address - Fax:
Practice Address - Street 1:5704 ELAINE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-5859
Practice Address - Country:US
Practice Address - Phone:269-343-3731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICI390395642320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities