MEDICARE: COMMUNITY INNOVATIONS,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063635639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY INNOVATIONS,INC.

Provider Business Mailing Address
First Line	:	2003 GODWIN AVE
Second Line	:	SUITE A
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3197
Country	:	US
Telephone Number	:	910-739-8849
Fax Number	:	910-739-5167

Provider Business Practice Location Address
First Line	:	2209 CENTURY DR
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27612-3941
Country	:	US
Telephone Number	:	919-786-4944
Fax Number	:	919-786-4945

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDY ANDERSON
Credential	:
Telephone Number	:	910-739-8849

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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