NPIMap

Organization Active NPI

Opportunity Foundation Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Williston, ND
National Provider Identifier
1811640808
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
OPPORTUNITY FOUNDATION INC
Practice address
612 E Broadway
Williston, ND 58801-6104
Phone
(701) 774-8593
Fax
(701) 572-8871
NPI assigned
Jan 31, 2022
Last updated
Jan 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrea J Peterson
Title
Financial Manager
Phone
(701) 774-8593

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

612 E Broadway
Williston, ND 58801-6104

Mailing address

PO Box 1627
Williston, ND 58802-1627
Phone (701) 774-8593

Other practice location 1

15 1st Street
Stanley, ND 58784
Phone (701) 628-2990 ext. 221

Other identifiers 1

IdentifierTypeStateIssuer
1455750MedicaidND

National Provider Directory

National Provider Directory
Tax ID family
Opportunity Foundation Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

15 1st St SE
Stanley, ND 58784
Phone 7016282990 ext. 221

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1811640808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1627",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588021627",
            "telephone_number": "701-774-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 E BROADWAY",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016104",
            "telephone_number": "701-774-8593",
            "fax_number": "701-572-8871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 1st Street",
            "address_purpose": "LOCATION",
            "city": "Stanley",
            "state": "ND",
            "postal_code": "58784",
            "country_code": "US",
            "telephone_number": "701-628-2990 x221",
            "fax_number": "701-572-8871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPPORTUNITY FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "701-774-8593"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455750",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.