Provider Demographics
NPI:1861715856
Name:BENEVOLENT CARE CENTERS, LLC
Entity type:Organization
Organization Name:BENEVOLENT CARE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENITHA
Authorized Official - Middle Name:SEBRINA
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:216-965-5040
Mailing Address - Street 1:13508 MAPLEROW AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6932
Mailing Address - Country:US
Mailing Address - Phone:216-956-2419
Mailing Address - Fax:216-662-2708
Practice Address - Street 1:13508 MAPLEROW AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6932
Practice Address - Country:US
Practice Address - Phone:216-956-2419
Practice Address - Fax:216-662-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-253537253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1810213OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES
OH2843641Medicaid