Provider Demographics
NPI:1669211660
Name:THE OPAL LINK, LLC
Entity type:Organization
Organization Name:THE OPAL LINK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CO-FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-244-6657
Mailing Address - Street 1:611 E PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7061
Practice Address - Country:US
Practice Address - Phone:719-244-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency