Provider Demographics
NPI:1205297702
Name:BENJAMIN HEALTHCARE
Entity type:Organization
Organization Name:BENJAMIN HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-845-3213
Mailing Address - Street 1:1881 W TRAVERSE PARKWAY
Mailing Address - Street 2:SUITE E#112
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 HOSPITAL DR STE 202
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-554-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059617Medicare Oscar/Certification