# INNOVATIVE COGNITIVE SERVICES, INC.

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

## Provider details

- **NPI number:** 1871709774
- **Authorized official:** DR. REGINALD LEE OXENDINE JR. EDD (PRESIDENT)
- **Authorized official phone:** (910) 521-3009

## Contact information

- **Practice address:** 410 SOUTH JONES STREET, PEMBROKE, NC 28372
- **Practice address phone:** (910) 521-3009
- **Practice address fax:** (910) 521-3010
- **Mailing address:** PO BOX 3695, PEMBROKE, NC 28372-3695
- **Mailing address phone:** (910) 521-3009
- **Mailing address fax:** (910) 521-3010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-078-191 | NC | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 05/14/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8302075 | — | NC |