NPIMap

Organization Active NPI

Benjamin House, Inc.

  • Community/Behavioral Health Agency
  • Elizabeth City, NC
National Provider Identifier
1588864482
Registry record updated Jul 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
8300836 Issued in NC
Legal business name
BENJAMIN HOUSE, INC.
Doing business as
Community Intervention Services Agency
Practice address
1221 Carolina Ave
Suite 3
Elizabeth City, NC 27909-5458
Phone
(252) 331-7731
Fax
(252) 331-1777
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2007

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

Authorized official

Name
Mr. David E Gilbert, QP
Title
Chief Executive Officer
Phone
(252) 331-7731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 8300836 NC Primary

Addresses

Primary practice location

1221 Carolina Ave
Suite 3
Elizabeth City, NC 27909-5458

Mailing address

1221 Carolina Ave
Suite 3
Elizabeth City, NC 27909-5458
Phone (252) 331-7731

Other identifiers 1

IdentifierTypeStateIssuer
8300836MedicaidNC

Other names 1

  • Community Intervention Services Agency Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benjamin House Community Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1221 Carolina Ave
Ste 3
Elizabeth City, NC 27909
Phone (252) 312-6494

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1588864482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 CAROLINA AVE",
            "address_2": "SUITE 3",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279095458",
            "telephone_number": "252-331-7731",
            "fax_number": "252-331-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 CAROLINA AVE",
            "address_2": "SUITE 3",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279095458",
            "telephone_number": "252-331-7731",
            "fax_number": "252-331-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "252-331-7731",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "8300836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300836",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Intervention Services Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.