Provider Demographics
NPI:1962984872
Name:THE OPPORTUNITY ALLIANCE
Entity type:Organization
Organization Name:THE OPPORTUNITY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-523-5018
Mailing Address - Street 1:50 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LYDIA LN
Practice Address - Street 2:
Practice Address - City:S PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2156
Practice Address - Country:US
Practice Address - Phone:207-874-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1942328356Medicaid