Provider Demographics
NPI:1275578379
Name:CHRISTIAN OPPORTUNITY CENTER
Entity Type:Organization
Organization Name:CHRISTIAN OPPORTUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-628-8087
Mailing Address - Street 1:1553 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1099
Mailing Address - Country:US
Mailing Address - Phone:641-628-1162
Mailing Address - Fax:641-628-8682
Practice Address - Street 1:1553 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1099
Practice Address - Country:US
Practice Address - Phone:641-628-1162
Practice Address - Fax:641-628-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0881151320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0109215Medicaid