Provider Demographics
NPI:1508933078
Name:OPPORTUNITY LIVING
Entity Type:Organization
Organization Name:OPPORTUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-464-8961
Mailing Address - Street 1:1890 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-7706
Mailing Address - Country:US
Mailing Address - Phone:712-464-8961
Mailing Address - Fax:712-464-3320
Practice Address - Street 1:1890 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-7706
Practice Address - Country:US
Practice Address - Phone:712-464-8961
Practice Address - Fax:712-464-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIMR556315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0880476Medicaid