Healthcare Provider Details

I. General information

NPI: 1295904001
Provider Name (Legal Business Name): IQUOLIOC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 BELL FORK RD
JACKSONVILLE NC
28540-6315
US

IV. Provider business mailing address

675 BELL FORK RD
JACKSONVILLE NC
28540-6315
US

V. Phone/Fax

Practice location:
  • Phone: 910-355-2000
  • Fax: 910-355-3047
Mailing address:
  • Phone: 910-355-2000
  • Fax: 910-355-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0700012694
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0700012694
License Number StateNC

VIII. Authorized Official

Name: TAMMY CLEVELAND
Title or Position: PRESIDENT
Credential:
Phone: 910-355-2000