Healthcare Provider Details

I. General information

NPI: 1922804525
Provider Name (Legal Business Name): C&C INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W SPRING ST
OXFORD NC
27565-3233
US

IV. Provider business mailing address

315 W SPRING ST
OXFORD NC
27565-3233
US

V. Phone/Fax

Practice location:
  • Phone: 919-339-6047
  • Fax:
Mailing address:
  • Phone: 919-339-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTIAN ANTIONETTE HARGROVE
Title or Position: OWNER/OPERATOR
Credential:
Phone: 252-767-1954