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	315P00000X	Intellectual Disabilities Intermediate Care Facility	MHL078049	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	:	1841375102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY INNOVATIONS INC

Provider Business Mailing Address
First Line	:	3210 FAIRHILL DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-3220
Country	:	US
Telephone Number	:	919-256-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 CREEK ROAD
Second Line	:
City	:	ORRUM
State	:	NC
Zip	:	28369-9269
Country	:	US
Telephone Number	:	910-618-0777
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	MR. HAROLD E JONES JR.
Credential	:
Telephone Number	:	919-256-0824

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/26/2007

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Directions to “COMMUNITY INNOVATIONS INC ” Practice Location

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