Provider Demographics
NPI:1558380915
Name:MARY BENSON HOUSE - ARP/PHOENIX
Entity Type:Organization
Organization Name:MARY BENSON HOUSE - ARP/PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-2700
Mailing Address - Street 1:PO BOX 16367
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0367
Mailing Address - Country:US
Mailing Address - Phone:828-252-8957
Mailing Address - Fax:828-255-8028
Practice Address - Street 1:450 MONTFORD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1015
Practice Address - Country:US
Practice Address - Phone:828-252-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL011106261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005260Medicaid
NC6005260Medicaid