=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922804525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C&C INNOVATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W SPRING ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-339-6047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 W SPRING ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-339-4067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | CHRISTIAN ANTIONETTE HARGROVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-767-1954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------