Provider Demographics
NPI:1104044569
Name:ROCKINGHAM OPPORTUNITIES CORP
Entity Type:Organization
Organization Name:ROCKINGHAM OPPORTUNITIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-342-4761
Mailing Address - Street 1:342 CHEROKEE CAMP RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8888
Mailing Address - Country:US
Mailing Address - Phone:336-342-4761
Mailing Address - Fax:336-342-0310
Practice Address - Street 1:342 CHEROKEE CAMP RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8888
Practice Address - Country:US
Practice Address - Phone:336-342-4761
Practice Address - Fax:336-342-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-079-034320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802265Medicaid