Provider Demographics
NPI:1467781054
Name:BENASIA HOUSE ADULT DAY ACTIVITY PROGRAM
Entity Type:Organization
Organization Name:BENASIA HOUSE ADULT DAY ACTIVITY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-939-9934
Mailing Address - Street 1:247 KYLE MAC WAY RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:NC
Mailing Address - Zip Code:27326-9602
Mailing Address - Country:US
Mailing Address - Phone:336-939-9934
Mailing Address - Fax:336-939-9935
Practice Address - Street 1:106 GILMER ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3870
Practice Address - Country:US
Practice Address - Phone:336-939-9934
Practice Address - Fax:336-939-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)