Provider Demographics
NPI:1710007224
Name:UNLIMTED OPPORTUNITIES, LLC
Entity Type:Organization
Organization Name:UNLIMTED OPPORTUNITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-8800
Mailing Address - Street 1:1328 ASHLEY SQ
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2919
Mailing Address - Country:US
Mailing Address - Phone:336-760-8800
Mailing Address - Fax:
Practice Address - Street 1:1328 ASHLEY SQ
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2919
Practice Address - Country:US
Practice Address - Phone:336-760-8800
Practice Address - Fax:336-765-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408677Medicaid