Provider Demographics
NPI:1073822912
Name:OLIVER ENTERPRISE
Entity Type:Organization
Organization Name:OLIVER ENTERPRISE
Other - Org Name:PROGRESSIVE BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-321-4934
Mailing Address - Street 1:PO BOX 20482
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:806 SOUTH TARBORO STREET
Practice Address - Street 2:STE B1
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-321-4934
Practice Address - Fax:252-493-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL098152251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health