Provider Demographics
NPI:1891830519
Name:BENEATH THE TREES DBA CORINTHIAN PLACE
Entity Type:Organization
Organization Name:BENEATH THE TREES DBA CORINTHIAN PLACE
Other - Org Name:CORINTHIAN PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:910-383-6235
Mailing Address - Street 1:1935 LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9187
Mailing Address - Country:US
Mailing Address - Phone:910-383-6235
Mailing Address - Fax:910-383-6248
Practice Address - Street 1:1935 LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9187
Practice Address - Country:US
Practice Address - Phone:910-383-6235
Practice Address - Fax:910-383-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL010006310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805476Medicaid