Organization
THE OPPORTUNITY ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN OUELLETTE (CHIEF FINANCIAL OFFICER)
(207) 874-1175
Entity
Organization
Contact information
Practice address
190 LANCASTER ST, PORTLAND, ME 04101-2056
(207) 874-1175
(207) 842-6886
Mailing address
50 LYDIA LN, SOUTH PORTLAND, ME 04106-2156
(207) 874-1175
(207) 842-6886
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003210
MEDICARE PTAN
ME
05
—
105460303
—
ME
Enumeration date
03/26/2007
Last updated
09/10/2019
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