NPIMap

Organization Active NPI

Community Innovations Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Orrum, NC
National Provider Identifier
1841375102
Registry record updated Jul 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL078049 Issued in NC
Legal business name
COMMUNITY INNOVATIONS INC
Practice address
467 Creek Road
Orrum, NC 28369-9269
Phone
(910) 618-0777
NPI assigned
Oct 26, 2006
Last updated
Jul 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Harold E Jones Jr.
Title
Senior Vice President
Phone
(919) 256-0824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL078049 NC Primary

Addresses

Primary practice location

467 Creek Road
Orrum, NC 28369-9269

Mailing address

3210 Fairhill Dr
Raleigh, NC 27612-3220
Phone (919) 256-0824

Other identifiers 1

IdentifierTypeStateIssuer
340602MMedicaidNC

Other names 1

  • Westside Residential Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841375102. Details of each certification follow.

  • CCN 34G243 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G243

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WESTSIDE RESIDENTIAL
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 16, 1992
Last certification
Apr 29, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
467 South Creek Road
Orrum, NC 28369

National Provider Directory

National Provider Directory
Tax ID family
Friendway Group Home48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Locations

467 S Creek Rd
Orrum, NC 28369
Phone (910) 618-0777

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1841375102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 FAIRHILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123220",
            "telephone_number": "919-256-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 CREEK ROAD",
            "city": "ORRUM",
            "state": "NC",
            "postal_code": "283699269",
            "telephone_number": "910-618-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY INNOVATIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "919-256-0824",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL078049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340602M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Residential",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orrum, NC

Sources for this page

Verify at the official NPI Registry.