Provider Demographics
NPI:1063635639
Name:COMMUNITY INNOVATIONS,INC.
Entity Type:Organization
Organization Name:COMMUNITY INNOVATIONS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-8849
Mailing Address - Street 1:2003 GODWIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3197
Mailing Address - Country:US
Mailing Address - Phone:910-739-8849
Mailing Address - Fax:910-739-5167
Practice Address - Street 1:2209 CENTURY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3941
Practice Address - Country:US
Practice Address - Phone:919-786-4944
Practice Address - Fax:919-786-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301839BMedicaid