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Organization
COMMUNITY INNOVATIONS INC
Active
Organization
COMMUNITY INNOVATIONS INC
Active
Other names
Timberlea Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY BENSON (REVENUE CYCLE DIRECTOR)
(365) 535-9463
Entity
Organization
Contact information
Practice address
5691 MACK LINEBERRY ROAD, CLIMAX, NC 27233-8076
(336) 685-4955
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
(919) 256-8750
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL076023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340608T
—
NC
Enumeration date
11/01/2006
Last updated
09/12/2023
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