Provider Demographics
NPI:1083821656
Name:COMMUNITY INNOVATIONS, INC.
Entity Type:Organization
Organization Name:COMMUNITY INNOVATIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MGR./ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-256-0824
Mailing Address - Street 1:3210 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3215
Mailing Address - Country:US
Mailing Address - Phone:919-256-0824
Mailing Address - Fax:919-256-0833
Practice Address - Street 1:704 PROGRESS PL
Practice Address - Street 2:SUITE B
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5545
Practice Address - Country:US
Practice Address - Phone:910-277-3212
Practice Address - Fax:910-277-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300959HMedicaid
NC8300959GMedicaid
NC8300959Medicaid
NC8300959VMedicaid
NC8300959BMedicaid