Organization
COMMUNITY INNOVATIONS INC 63
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY ANDERSON (PRESIDENT)
(910) 642-5697
Entity
Organization
Contact information
Practice address
904 AVENT FERRY RD, HOLLY SPRINGS, NC 27540-8416
(919) 577-6749
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
MHL092126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340605J
—
NC
Enumeration date
10/26/2006
Last updated
08/22/2020
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