Provider Demographics
NPI:1750856761
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 423
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0423
Mailing Address - Country:US
Mailing Address - Phone:701-628-2990
Mailing Address - Fax:701-572-8871
Practice Address - Street 1:15 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-9065
Practice Address - Country:US
Practice Address - Phone:701-628-2990
Practice Address - Fax:701-572-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND=========Medicaid