Organization
COMMUNITY INNOVATIONS INC
Active
Other names
Timberlea Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY BENSON (REVENUE CYCLE DIRECTOR)
(365) 535-9463
Entity
Organization
Contact information
Practice address
5691 MACK LINEBERRY ROAD, CLIMAX, NC 27233-8076
(336) 685-4955
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3220
(919) 256-0824
(919) 256-8750
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL076023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340608T
—
NC
Enumeration date
11/01/2006
Last updated
09/12/2023
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