Provider Demographics
NPI:1508654005
Name:OUT OF THE BLUE INNOVATIONS LLC
Entity type:Organization
Organization Name:OUT OF THE BLUE INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, CEAC, ATP
Authorized Official - Phone:910-228-6673
Mailing Address - Street 1:77 BUCCANEER BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7167
Mailing Address - Country:US
Mailing Address - Phone:910-228-6673
Mailing Address - Fax:910-595-8024
Practice Address - Street 1:77 BUCCANEER BLVD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7167
Practice Address - Country:US
Practice Address - Phone:910-228-6673
Practice Address - Fax:910-595-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services