Basic Information
| Provider Information | |||||||||
| NPI: | 1154557452 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE OPPORTUNITY ALLIANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 MONUMENT SQ | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041014039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078741175 | ||||||||
| FaxNumber: | 2078741181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041064110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078741175 | ||||||||
| FaxNumber: | 2078741181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GENTILE | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2078741175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 105460303 | 05 | ME | MEDICAID |