Provider Demographics
NPI:1235553595
Name:BENEVOLENCE INDUSTRIES INC.
Entity Type:Organization
Organization Name:BENEVOLENCE INDUSTRIES INC.
Other - Org Name:BENEVOLENCE HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-800-7963
Mailing Address - Street 1:934 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4515
Mailing Address - Country:US
Mailing Address - Phone:562-437-1855
Mailing Address - Fax:562-437-1860
Practice Address - Street 1:934 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4515
Practice Address - Country:US
Practice Address - Phone:562-437-1855
Practice Address - Fax:562-437-1860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEVOLENCE INDUSTRIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)