Provider Demographics
NPI:1497895684
Name:BENNICK, INC.
Entity Type:Organization
Organization Name:BENNICK, INC.
Other - Org Name:MT. VIEW FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-584-7841
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:3341 OLD HIGHWAY #10, EAST
Mailing Address - City:NEBO
Mailing Address - State:NC
Mailing Address - Zip Code:28761-0001
Mailing Address - Country:US
Mailing Address - Phone:828-584-7841
Mailing Address - Fax:828-584-9725
Practice Address - Street 1:3341 OLD HIGHWAY #10, EAST
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-0001
Practice Address - Country:US
Practice Address - Phone:828-584-7841
Practice Address - Fax:828-584-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH-059-010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801346Medicaid