Provider Demographics
NPI:1730902594
Name:BENEVOLENT HOME GROUP LLC
Entity type:Organization
Organization Name:BENEVOLENT HOME GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKIRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-275-3938
Mailing Address - Street 1:13260 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2819
Mailing Address - Country:US
Mailing Address - Phone:248-989-5552
Mailing Address - Fax:
Practice Address - Street 1:4814 PEBBLE CRK N APT 8
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4891
Practice Address - Country:US
Practice Address - Phone:248-275-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health