Provider Demographics
NPI:1518193812
Name:THE OPPORTUNITY ALLIANCE
Entity Type:Organization
Organization Name:THE OPPORTUNITY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-523-5018
Mailing Address - Street 1:50 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2156
Mailing Address - Country:US
Mailing Address - Phone:207-874-1175
Mailing Address - Fax:207-874-1181
Practice Address - Street 1:50 LYDIA LN
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2156
Practice Address - Country:US
Practice Address - Phone:207-874-1175
Practice Address - Fax:207-874-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME105460200Medicaid
ME105460229Medicaid
ME105460218Medicaid
ME105460226Medicaid
ME105460227Medicaid
ME105460212Medicaid
ME105460215Medicaid
ME105460233Medicaid
ME105460202Medicaid
ME105460205Medicaid
ME105460201Medicaid
ME105460217Medicaid
ME105460225Medicaid
ME105460228Medicaid
ME105460206Medicaid
ME105460230Medicaid
ME105460203Medicaid
ME105460231Medicaid
ME105460204Medicaid