Provider Demographics
NPI:1023138740
Name:UNLIMITED OPPORTUNITIES, LLC
Entity type:Organization
Organization Name:UNLIMITED 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 1:4401 NORTH CHERRY STREET
Mailing Address - Street 2:STE 60
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2500
Mailing Address - Country:US
Mailing Address - Phone:336-760-8800
Mailing Address - Fax:336-765-0100
Practice Address - Street 1:4401 NORTH CHERRY STREET
Practice Address - Street 2:STE 60
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2500
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:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60066891041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301372Medicaid
NC8301372BMedicaid
NC6006689Medicaid
NC8301372HMedicaid