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COMMUNITY INNOVATIONS INC 64

Intermediate Care Facility, Mentally Retarded

Holly Springs, North Carolina

Provider NPI: 1750469698

Organization Information:
Organization Name:  COMMUNITY INNOVATIONS INC 64


Practice Location:
912 AVENT FERRY RD  HOLLY SPRINGS, NC 27540 US
Tel: 919-557-6337  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
NCMHL092131

Other Provider Identifiers:

IssuerNumberStateType
340605WNC05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS NC - Page 1



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