Organization
COMMUNITY INNOVATIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOHNS BENSON (REVENUE CYCLE DIRECTOR)
(704) 995-2131
Entity
Organization
Contact information
Practice address
202 FRIENDWAY RD, GREENSBORO, NC 27409-2116
(336) 852-2636
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
MHL041070
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3416216
—
NC
Enumeration date
11/01/2006
Last updated
05/15/2023
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