Provider Demographics
NPI:1962898296
Name:OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Entity type:Organization
Organization Name:OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONK-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-212-3486
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-210-9873
Mailing Address - Fax:252-212-3497
Practice Address - Street 1:300 N GRACE ST STE 200
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5346
Practice Address - Country:US
Practice Address - Phone:252-210-9873
Practice Address - Fax:252-212-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)