Provider Demographics
NPI:1346613387
Name:BUSINESS OPPORTUNITIES FOR SELF SUFFICERNCY
Entity Type:Organization
Organization Name:BUSINESS OPPORTUNITIES FOR SELF SUFFICERNCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JERETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-376-6503
Mailing Address - Street 1:PO BOX 71320
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-1320
Mailing Address - Country:US
Mailing Address - Phone:253-376-6503
Mailing Address - Fax:
Practice Address - Street 1:2501 HUNTING BOW DRIVE
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28307-1320
Practice Address - Country:US
Practice Address - Phone:253-376-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1422118251300000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies