Provider Demographics
NPI:1336336767
Name:IQUOLIOC, INC.
Entity Type:Organization
Organization Name:IQUOLIOC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-355-2000
Mailing Address - Street 1:675 BELL FORK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6315
Mailing Address - Country:US
Mailing Address - Phone:910-355-2000
Mailing Address - Fax:910-355-6900
Practice Address - Street 1:675 BELL FORK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6315
Practice Address - Country:US
Practice Address - Phone:910-355-2000
Practice Address - Fax:910-355-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409548Medicaid
NC8301171Medicaid