Provider Demographics
NPI:1255055026
Name:OPPORTUNITY CHANGES COMMUNITIES LLC
Entity type:Organization
Organization Name:OPPORTUNITY CHANGES COMMUNITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL TECHNICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-675-9285
Mailing Address - Street 1:460 N MESA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5974
Mailing Address - Country:US
Mailing Address - Phone:301-675-9285
Mailing Address - Fax:
Practice Address - Street 1:460 N MESA DR STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5974
Practice Address - Country:US
Practice Address - Phone:301-675-9285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health