Organization
INNOVATIVE FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANI DAVIS HARRISON JD (PRESIDENT)
(919) 889-1571
Entity
Organization
Contact information
Practice address
2515 NC HWY 55 STE A, DURHAM, NC 27713-1374
(919) 596-0094
Mailing address
2515 NC HWY 55 STE A, DURHAM, NC 27713-1374
(919) 596-0094
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008377
—
NC
Enumeration date
09/20/2010
Last updated
06/07/2011
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