Healthcare Provider Details

I. General information

NPI: 1235295734
Provider Name (Legal Business Name): BRENDEX RENEA LEE MEEKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W SYCAMORE ST
ZEBULON NC
27597-2530
US

IV. Provider business mailing address

PO BOX 1383
WENDELL NC
27591-1383
US

V. Phone/Fax

Practice location:
  • Phone: 919-404-2426
  • Fax:
Mailing address:
  • Phone: 919-266-2003
  • Fax: 919-266-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-573
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-663
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-092-488
License Number StateNC

VIII. Authorized Official

Name: BRENDEX RENEA MEEKS
Title or Position: OWNER/OFFICE ADMINISTRATOR
Credential:
Phone: 919-390-4429