OrganizationActive
Community Innovations Inc 63
NPI 1407931611 · Intellectual Disabilities Intermediate Care Facility · Holly Springs, NC
Provider details
- NPI number
- 1407931611
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Andy Anderson, President(910) 642-5697
- License
- MHL092126 (NC)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
904 Avent Ferry Rd
Holly Springs, NC 27540-8416
Phone: (919) 577-6749
Street-level locationGet directions
Mailing address
3210 Fairhill Dr
Raleigh, NC 27612-3220
Registry dates
- Enumerated
- 2006-10-26
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.