1497166672 NPI number — BENEVOLENCE INDUSTRIES INCORPORATED

Table of content: (NPI 1497166672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497166672 NPI number — BENEVOLENCE INDUSTRIES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEVOLENCE INDUSTRIES INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BENEVOLENCE HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497166672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 W LA VETA AVE
Provider Second Line Business Mailing Address:
110
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-289-8800
Provider Business Mailing Address Fax Number:
714-633-9928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 W LA VETA AVE
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-289-8800
Provider Business Practice Location Address Fax Number:
714-633-9928
Provider Enumeration Date:
05/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OBENG
Authorized Official First Name:
KWABENA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ PRESIDENT
Authorized Official Telephone Number:
310-800-7963

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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