Provider Demographics
NPI:1063470656
Name:INNOVATIVE PROGRAMMING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE PROGRAMMING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-0734
Mailing Address - Street 1:111 LAMON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4957
Mailing Address - Country:US
Mailing Address - Phone:910-483-0734
Mailing Address - Fax:910-483-9403
Practice Address - Street 1:1134 N ROAD ST STE 6
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-338-9005
Practice Address - Fax:252-338-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM0801X, 261QR0405X, 320600000X, 320900000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300767BMedicaid
NC8300767IMedicaid
NC8300767JMedicaid
NC8300767GMedicaid
NC8300767HMedicaid
NC8300767QMedicaid
NC8300767Medicaid
NC8300767AMedicaid
NC6103427Medicaid