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General NPI Number Information
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NPI Number | 1508654005
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Entity Type | Organization
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Legal Business Name | OUT OF THE BLUE INNOVATIONS LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 77 BUCCANEER BLVD
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City | HAMPSTEAD
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State | NC
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Zip | 28443-7167
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Country | US
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Telephone | 910-228-6673
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Fax | 910-595-8024
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Provider Business Mailing Address
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Address Line | 77 BUCCANEER BLVD
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City | HAMPSTEAD
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State | NC
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Zip | 28443-7167
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Country | US
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Telephone | 910-228-6673
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Fax | 910-595-8024
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Authorized Official
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Title or Position | OWNER
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Name | LORI ADCOCK
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Credential | BBA, CEAC, ATP
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Telephone | 910-228-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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