Opportunities Industrialization Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Rocky Mount, NC
NPI 1932923950 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1932923950
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
- Practice address
- 90 Guardian CT
Rocky Mount, NC 27804-3017 - Phone
- (252) 212-3350
- Fax
- (888) 980-1017
- NPI assigned
- Nov 15, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
Authorized official
- Name
- Shirley Monk-Jones
- Title
- Billing Director
- Phone
- (252) 212-3486
Owners & managing parties with NPI records 6
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 6
Practitioners 47
-
Earic Ramon Bonner, M.D.
-
Toshia Chipman, PMHNP
-
Hattie Denice Clayton, PMHNP
-
Jean Mary Coles, LPC; LCMHC
-
Denise Lynne Davis, PMHNP
-
Sarini Ettigi, PHD
-
Jessica Swink Fulk, PA-C
-
Nicole Faucette Habit, DNP, PMHNP-BC, FNP-C
-
Jasmine Hamilton, LCSW
-
Kenyetta Hardy, LCSW
-
Brandy Harrell, LCAS
-
Nicole Wirth Harry, PMHNP-BC
-
Joy Hinnant, FNP-C
-
Monyetta Marie Howell, LCMHC-A, LCAS-A, NCC
-
Sheila Locklear Hunt, PMHNP-BC
-
Belisa Fasha Kershaw, LCMHC
-
Brianne C Klinger, PMHNP-BC, FNP-BC
-
Paulisha Da-Shawna McIntyre, BSW, MSW, LCSW-A
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341045
- Legal name
- OPPORTUNITIES INDUSTRIALIZATION CENTER, INC
- Doing business as
- OIC FAMILY MEDICAL CENTER GUARDIAN COURT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 20, 2016
- Last certification
- Jul 20, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 19, 1969 in NC
- Enrollment address
- 90 Guardian CT
Rocky Mount, NC 27804-3017
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Brenda F Cutchin |
Corporate Director |
Jul 1, 2013 | |
| Shirley Monk-Jones |
W-2 Managing Employee |
Dec 1, 2011 | |
| Chayan Tiwari |
Operational/Managerial Control | Apr 1, 2023 | |
| Reuben Blackwell |
Corporate Officer |
Sep 6, 2007 | |
| Opportunities Industrialization Center, Inc |
Operational/Managerial Control | Jan 14, 2005 | |
| Sherri Bryant |
Operational/Managerial Control | Apr 1, 2023 | |
| Samuel Dickens |
Corporate Officer |
Jan 1, 2009 | |
| Mary Johnson Mann |
Corporate Director | Apr 1, 2005 | |
| Donna Johnson |
Corporate Director |
Apr 1, 2005 | |
| Hubert D Pope |
Corporate Director |
Jan 1, 2011 | |
| Andre Knight |
Corporate Director |
Jan 1, 2000 | |
| Doris K Thorne |
Corporate Director |
Jan 1, 2011 | |
| Evelyn Wilson |
Corporate Director |
Apr 1, 2005 | |
| Leonard Tillery |
Corporate Director |
Jul 1, 2013 | |
| Brian Ellerby |
Corporate Officer |
Jun 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160720000567 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 3173563590 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rocky Mount, NC |
| O20161104000262 | NC | Part B Supplier - Clinic/Group Practice | 3173563590 |
Receives reassigned benefits from 48 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rocky Mount, NC |
National Provider Directory
- Tax ID family
- Rocky Mount Oic Family Medical Center
- Part of
- Rocky Mount Oic Family Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
90 Guardian CT
Rocky Mount, NC 27804-3017
Mailing address
PO Box 2723
Rocky Mount, NC 27802-2723
Phone (252) 212-3486
Other names
- OIC FAMILY MEDICAL CENTER LTC
Other providers in Rocky Mount, NC
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc
- Opportunities Industrialization Center, Inc.
- Opportunities Industrialization Center, Inc.
- Opulent Body Wellness and Day Spa
- Our Story Counseling PLLC
All providers in Rocky Mount, NC · Federally Qualified Health Center (FQHC) in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.