Provider Demographics
NPI:1780043588
Name:LIVING OPPORTUNITIES
Entity Type:Organization
Organization Name:LIVING OPPORTUNITIES
Other - Org Name:KIMBALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-466-1678
Mailing Address - Street 1:3142 N COUNTY LINE RD
Mailing Address - Street 2:P.O. BOX 271
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-7604
Mailing Address - Country:US
Mailing Address - Phone:440-466-1678
Mailing Address - Fax:
Practice Address - Street 1:3142 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9705
Practice Address - Country:US
Practice Address - Phone:440-466-1678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING OPPORTUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH28268315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077944Medicaid
OH0217214Medicaid