Provider Demographics
NPI:1942562541
Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Entity Type:Organization
Organization Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-813-2530
Mailing Address - Street 1:2109 SAINT ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2149
Mailing Address - Country:US
Mailing Address - Phone:252-641-4522
Mailing Address - Fax:252-641-5461
Practice Address - Street 1:2109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1920
Practice Address - Country:US
Practice Address - Phone:252-641-4522
Practice Address - Fax:252-641-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942562541Medicaid