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General NPI Number Information
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NPI Number | 1578872560
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Entity Type | Organization
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Legal Business Name | OLIVER ENTERPRISE LLC
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Dates
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Enumeration Date | 09/25/2010
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Last Update Date | 09/25/2010
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Provider Practice Location Address
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Address Line | 1700 E ARLINGTON BLVD STE D
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City | GREENVILLE
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State | NC
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Zip | 27858-7842
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Country | US
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Telephone | 252-321-4934
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Fax | 252-493-7166
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Provider Business Mailing Address
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Address Line | PO BOX 20482
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City | GREENVILLE
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State | NC
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Zip | 27858-0482
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | LISA OLIVER
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Credential |
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Telephone | 252-321-4934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL074226
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License Number State | NC
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