Healthcare Provider Details

I. General information

NPI: 1760854681
Provider Name (Legal Business Name): COMMUNITY INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 FAIRHILL DR
RALEIGH NC
27612-3215
US

IV. Provider business mailing address

3210 FAIRHILL DR
RALEIGH NC
27612-3215
US

V. Phone/Fax

Practice location:
  • Phone: 919-256-0824
  • Fax:
Mailing address:
  • Phone: 919-256-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC2950
License Number StateNC

VIII. Authorized Official

Name: MR. HAROLD E JONES JR.
Title or Position: SENIOR VP
Credential:
Phone: 919-256-0824