Healthcare Provider Details

I. General information

NPI: 1528198777
Provider Name (Legal Business Name): INNOVATIVE PROGRAMMING ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST STE 6
ELIZABETH CITY NC
27909-3365
US

IV. Provider business mailing address

111 LAMON ST STE 201
FAYETTEVILLE NC
28301-4957
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-9005
  • Fax: 252-338-9007
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMHL-070-037
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberMHL-070-037
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-070-033
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-070-037
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: LESLIE COLEY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 910-483-0734