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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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