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General NPI Number Information
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NPI Number | 1366756637
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Entity Type | Organization
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Legal Business Name | THE BENAIAH GROUP
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 2207 E CONE BLVD
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City | GREENSBORO
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State | NC
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Zip | 27405-4858
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Country | US
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Telephone | 336-375-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 E CONE BLVD
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City | GREENSBORO
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State | NC
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Zip | 27405-4858
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL LOUIS PRAYLOR
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Credential |
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Telephone | 336-471-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 041973
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License Number State | NC
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