Provider Demographics
NPI:1750734307
Name:OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.
Entity type:Organization
Organization Name:OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-212-3480
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-962-3450
Mailing Address - Fax:252-962-3451
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:MEDICAL PLAZA B
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-962-3450
Practice Address - Fax:252-962-3451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPPORTUNITIES INDUSTRIALIZATION CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)