Provider Demographics
NPI:1346406683
Name:OPPORTUNITES FOR THE RETARDED, INC.
Entity Type:Organization
Organization Name:OPPORTUNITES FOR THE RETARDED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-622-3929
Mailing Address - Street 1:64-1510 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2915
Mailing Address - Country:US
Mailing Address - Phone:808-622-3929
Mailing Address - Fax:808-621-8227
Practice Address - Street 1:64-1510 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2915
Practice Address - Country:US
Practice Address - Phone:808-622-3929
Practice Address - Fax:808-621-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI553380-01Medicaid