Provider Demographics
NPI:1396484820
Name:OPPORTUNITY COMMUNITY SERVICES INC
Entity type:Organization
Organization Name:OPPORTUNITY COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:NCHANG
Authorized Official - Last Name:KUKWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-330-1559
Mailing Address - Street 1:1399 GENEVA AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5761
Mailing Address - Country:US
Mailing Address - Phone:651-330-1559
Mailing Address - Fax:651-666-2807
Practice Address - Street 1:1399 GENEVA AVE N STE 201
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5761
Practice Address - Country:US
Practice Address - Phone:651-330-1559
Practice Address - Fax:651-666-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health