Basic Information
| Provider Information | |||||||||
| NPI: | 1851625180 | ||||||||
| 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: | 2078426886 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 MONUMENT SQ | ||||||||
| Address2: | 5TH FLOOR-FINANCE | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041014039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078741175 | ||||||||
| FaxNumber: | 2078426886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2009 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | GENTILE | ||||||||
| AuthorizedOfficialFirstName: | GINNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2078741175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 468400 | ME | Y | Agencies | Community/Behavioral Health |
No ID Information.