Organization
COMMUNITY INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY ANDERSON (PRESIDENT)
(910) 642-5697
Entity
Organization
Contact information
Practice address
704 PROGRESS PL, LAURINBURG, NC 28352-5545
(910) 277-3212
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
(919) 256-8750
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006053
—
NC
Enumeration date
05/29/2007
Last updated
04/30/2008
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