Healthcare Provider Details

I. General information

NPI: 1255223525
Provider Name (Legal Business Name): NISYJA CARES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 BALSOM RD
PFAFFTOWN NC
27040-8721
US

IV. Provider business mailing address

4450 BALSOM RD
PFAFFTOWN NC
27040-8722
US

V. Phone/Fax

Practice location:
  • Phone: 336-809-1039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICORIAH BENNETT
Title or Position: PARTNER
Credential:
Phone: 336-255-3813