Provider Demographics
NPI:1376147751
Name:OPPORTUNITY FOUNDATION INC
Entity Type:Organization
Organization Name:OPPORTUNITY FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-774-8593
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1627
Mailing Address - Country:US
Mailing Address - Phone:701-774-8593
Mailing Address - Fax:701-572-8871
Practice Address - Street 1:612 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6104
Practice Address - Country:US
Practice Address - Phone:701-774-8593
Practice Address - Fax:701-572-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456397Medicaid