Provider Demographics
NPI:1548200934
Name:OPPORTUNITY HOUSE, INC.
Entity Type:Organization
Organization Name:OPPORTUNITY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KROOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-5108
Mailing Address - Street 1:202 LUCAS ST
Mailing Address - Street 2:P.O. BOX 9
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1214
Mailing Address - Country:US
Mailing Address - Phone:815-895-5108
Mailing Address - Fax:815-895-9840
Practice Address - Street 1:202 LUCAS ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1214
Practice Address - Country:US
Practice Address - Phone:815-895-5108
Practice Address - Fax:815-895-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
IL91C046320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities