Provider Demographics
NPI:1023158565
Name:BENNICK, INC.
Entity type:Organization
Organization Name:BENNICK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
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 2:405 JACK CORPENING ROAD
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0205
Mailing Address - Country:US
Mailing Address - Phone:828-584-7841
Mailing Address - Fax:828-584-9725
Practice Address - Street 1:405 JACK CORPENING ROAD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761
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:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-059-029310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility