Provider Demographics
NPI:1649049081
Name:SMALLTOWN OPPORTUNITIES INC
Entity type:Organization
Organization Name:SMALLTOWN OPPORTUNITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:606-216-4940
Mailing Address - Street 1:1087 UPPER SECOND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9527
Mailing Address - Country:US
Mailing Address - Phone:606-216-4940
Mailing Address - Fax:
Practice Address - Street 1:1087 UPPER SECOND CREEK RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9527
Practice Address - Country:US
Practice Address - Phone:606-216-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities