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General NPI Number Information
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NPI Number | 1871709774
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COGNITIVE SERVICES, INC.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 410 SOUTH JONES STREET
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City | PEMBROKE
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State | NC
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Zip | 28372
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Country | US
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Telephone | 910-521-3009
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Fax | 910-521-3010
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Provider Business Mailing Address
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Address Line | PO BOX 3695
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City | PEMBROKE
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State | NC
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Zip | 28372-3695
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Country | US
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Telephone | 910-521-3009
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Fax | 910-521-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REGINALD LEE OXENDINE JR.
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Credential | EDD
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Telephone | 910-521-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-078-191
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License Number State | NC
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