Provider Demographics
NPI:1386707644
Name:BENJAMIN HOUSE, INC.
Entity type:Organization
Organization Name:BENJAMIN HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-338-0333
Mailing Address - Street 1:1221 CAROLINA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5407
Mailing Address - Country:US
Mailing Address - Phone:252-331-7731
Mailing Address - Fax:252-331-1777
Practice Address - Street 1:1221 CAROLINA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5407
Practice Address - Country:US
Practice Address - Phone:252-331-7731
Practice Address - Fax:252-331-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8300836B251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300836BMedicaid