NPIMap

Organization Active NPI

Benjamin House, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Elizabeth City, NC
National Provider Identifier
1821159278
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
3408242 Issued in NC
Legal business name
BENJAMIN HOUSE, INC.
Doing business as
Benjamin House Community Services
Practice address
848 Forest Park Road
Elizabeth City, NC 27909-5461
Phone
(252) 331-7731
Fax
(252) 331-1777
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Authorized official

Name
Mrs. Jayne Jones Hollowell, BA
Title
Director
Phone
(252) 331-7731

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 3408242 NC Primary
Adult Care Home Facility 311ZA0620X MHL-070-039 NC

Addresses

Primary practice location

848 Forest Park Road
Elizabeth City, NC 27909-5461

Mailing address

PO Box 757
Elizabeth City, NC 27907-0757
Phone (252) 331-7731

Other identifiers 1

IdentifierTypeStateIssuer
3408242MedicaidNC

Other names 1

  • Benjamin House Community Services 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

848 Forest Park Rd
Elizabeth City, NC 27909
Phone (252) 331-7731

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1821159278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 757",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279070757",
            "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": "848 FOREST PARK ROAD",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279095461",
            "telephone_number": "252-331-7731",
            "fax_number": "252-331-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "HOLLOWELL",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_middle_name": "JONES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "252-331-7731",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "3408242",
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-070-039",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408242",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benjamin House Community Services",
            "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 Mar 18, 2016; 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.