Healthcare Provider Details

I. General information

NPI: 1235043175
Provider Name (Legal Business Name): COMMUNITY SOAR PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 DAWSON CABIN RD
JACKSONVILLE NC
28540-9529
US

IV. Provider business mailing address

2568 DAWSON CABIN RD
JACKSONVILLE NC
28540-9529
US

V. Phone/Fax

Practice location:
  • Phone: 910-750-8013
  • Fax:
Mailing address:
  • Phone: 910-750-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICIA ANNE BENEFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential: BSW
Phone: 910-750-8013