Provider Demographics
NPI:1093970105
Name:NC FAMILY EMPOWERMENT ZONE
Entity Type:Organization
Organization Name:NC FAMILY EMPOWERMENT ZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EUGEN
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-831-2921
Mailing Address - Street 1:PO BOX 2717
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2717
Mailing Address - Country:US
Mailing Address - Phone:757-831-2921
Mailing Address - Fax:
Practice Address - Street 1:2012 N ROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9361
Practice Address - Country:US
Practice Address - Phone:757-831-2921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19778251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health