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Organization
INGENIOUS HEALTH CARE
Active
Organization
INGENIOUS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORENZO HUDSON (MANAGER)
(704) 904-8684
Entity
Organization
Contact information
Practice address
420 WEST BLVD, CHARLOTTE, NC 28203-4408
(704) 297-6776
Mailing address
420 WEST BLVD, CHARLOTTE, NC 28203-4408
(704) 297-6776
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
Primary
—
NC
251B00000X
Case Management Agency
—
NC
251E00000X
Home Health Agency
—
NC
251S00000X
Community/Behavioral Health Agency
—
NC
252Y00000X
Early Intervention Provider Agency
—
NC
253Z00000X
In Home Supportive Care Agency
—
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NC
385HR2055X
Child Mental Illness Respite Care
—
NC
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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