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Organization
COMMUNITY INNOVATIONS INC
Active
Organization
COMMUNITY INNOVATIONS INC
Active
Other names
Westside Residential
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAROLD E JONES JR. (SENIOR VICE PRESIDENT)
(919) 256-0824
Entity
Organization
Contact information
Practice address
467 CREEK ROAD, ORRUM, NC 28369-9269
(910) 618-0777
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL078049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340602M
—
NC
Enumeration date
10/26/2006
Last updated
07/26/2007
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