Provider Demographics
NPI:1194854075
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 ASSISTANT
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 STE 201
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 1:4011 UNIVERSITY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2549
Practice Address - Country:US
Practice Address - Phone:919-683-5672
Practice Address - Fax:919-403-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR0405X, 320600000X, 320900000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301288RMedicaid
NC8301288Medicaid
NC8301288GMedicaid
NC8301288BMedicaid
NC8301288HMedicaid