Provider Demographics
NPI:1942422241
Name:WIDER OPPORTUNITIES INC
Entity Type:Organization
Organization Name:WIDER OPPORTUNITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:660-213-3290
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:MO
Mailing Address - Zip Code:63447-0225
Mailing Address - Country:US
Mailing Address - Phone:660-213-3290
Mailing Address - Fax:660-213-3291
Practice Address - Street 1:410 STATE ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:MO
Practice Address - Zip Code:63447-0225
Practice Address - Country:US
Practice Address - Phone:660-213-3290
Practice Address - Fax:660-213-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)