# INGENIOUS HEALTH CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093160178
- **Authorized official:** DORENZO HUDSON (MANAGER)
- **Authorized official phone:** (704) 904-8684

## Contact information

- **Practice address:** 420 WEST BLVD, CHARLOTTE, NC 28203-4408
- **Practice address phone:** (704) 297-6776
- **Mailing address:** 420 WEST BLVD, CHARLOTTE, NC 28203-4408
- **Mailing address phone:** (704) 297-6776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225XM0800X | Mental Health Occupational Therapist | — | NC | Yes |
| 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