Healthcare Provider Details

I. General information

NPI: 1033036074
Provider Name (Legal Business Name): ELIJAH JAMES BENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ALLEN C LILLY RD
HINTON WV
25951-9408
US

IV. Provider business mailing address

55 ALLEN C LILLY RD
HINTON WV
25951-9408
US

V. Phone/Fax

Practice location:
  • Phone: 304-660-8859
  • Fax:
Mailing address:
  • Phone: 304-660-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: