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
313 E BROOKWOOD AVENUE, LIBERTY, NC 27298-2608
(336) 622-3003
Mailing address
4000 PARAMOUNT PKWY STE 100, MORRISVILLE, NC 27560-8484
(919) 390-2980
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL076022
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340608F
—
NC
Enumeration date
11/01/2006
Last updated
04/27/2023
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