Provider Demographics
NPI:1114305067
Name:COMPANION EXTRAORDINAIRE HOME HEALTH CARE
Entity Type:Organization
Organization Name:COMPANION EXTRAORDINAIRE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENINGHOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-752-2205
Mailing Address - Street 1:P.O. BOX 734
Mailing Address - Street 2:112 ENGLAND STREET SUITE A
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005
Mailing Address - Country:US
Mailing Address - Phone:804-752-2205
Mailing Address - Fax:804-752-3403
Practice Address - Street 1:112 ENGLAND STREET
Practice Address - Street 2:SUITE A
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005
Practice Address - Country:US
Practice Address - Phone:804-752-2205
Practice Address - Fax:804-752-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty