1255416376 NPI number — COMMUNITY INNOVATIONS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255416376 NPI number — COMMUNITY INNOVATIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY INNOVATIONS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255416376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 PARAMOUNT PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-8484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
47-995-2131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 CAROLINA AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AHOSKIE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27910-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-209-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JOHNS
Authorized Official Title or Position:
REVENUE CYCLE DIRECTOR
Authorized Official Telephone Number:
704-995-2131

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  MHL046006 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 340607M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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