Healthcare Provider Details

I. General information

NPI: 1891830519
Provider Name (Legal Business Name): BENEATH THE TREES DBA CORINTHIAN PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 LINCOLN ROAD
LELAND NC
28451-9187
US

IV. Provider business mailing address

1935 LINCOLN ROAD
LELAND NC
28451-9187
US

V. Phone/Fax

Practice location:
  • Phone: 910-383-6235
  • Fax: 910-383-6248
Mailing address:
  • Phone: 910-383-6235
  • Fax: 910-383-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL010006
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberHAL010006
License Number StateNC

VIII. Authorized Official

Name: MR. WAYNE BRYANT SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-383-6235