1861715856 NPI number — BENEVOLENT CARE CENTERS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861715856 NPI number — BENEVOLENT CARE CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEVOLENT CARE CENTERS, LLC
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:
Provider Other Organization Name Type Code:
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:
1861715856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13508 MAPLEROW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARFIELD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44105-6932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-956-2419
Provider Business Mailing Address Fax Number:
216-662-2708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13508 MAPLEROW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44105-6932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-956-2419
Provider Business Practice Location Address Fax Number:
216-662-2708
Provider Enumeration Date:
03/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
BENITHA
Authorized Official Middle Name:
SEBRINA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
216-965-5040

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  RN-253537 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1810213 . This is a "OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2843641 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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