Provider Demographics
NPI:1013161587
Name:OPPORTUNITY DEVELOPMENT CENTERS, INC.
Entity Type:Organization
Organization Name:OPPORTUNITY DEVELOPMENT CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-818-6443
Mailing Address - Street 1:1191 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6364
Mailing Address - Country:US
Mailing Address - Phone:715-424-2750
Mailing Address - Fax:
Practice Address - Street 1:1191 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6364
Practice Address - Country:US
Practice Address - Phone:715-424-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)