Organization
SUPERIOR INNOVATIVE SERVICES II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES DAVIS (CEO)
(910) 352-9720
Entity
Organization
Contact information
Practice address
5000 BLUE CLAY RD STE D, CASTLE HAYNE, NC 28429-6302
(910) 352-9720
Mailing address
PO BOX 308, HAMPSTEAD, NC 28443-0308
(910) 352-9720
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
332U00000X
Home Delivered Meals
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
04/25/2026
Last updated
04/25/2026
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