Provider Demographics
NPI:1932628989
Name:REANIMATIONS
Entity Type:Organization
Organization Name:REANIMATIONS
Other - Org Name:REANIMATIONS BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QMHP, CPSS
Authorized Official - Phone:704-666-5218
Mailing Address - Street 1:4423 FAIR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5939
Mailing Address - Country:US
Mailing Address - Phone:704-264-9717
Mailing Address - Fax:704-666-5218
Practice Address - Street 1:208 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4233
Practice Address - Country:US
Practice Address - Phone:704-666-5218
Practice Address - Fax:704-666-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X, 251C00000X, 251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable