Provider Demographics
NPI:1427549757
Name:BENEVOLENCE HOMECARE LLC
Entity Type:Organization
Organization Name:BENEVOLENCE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHETISKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-238-3965
Mailing Address - Street 1:115 TEAL WAY
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-3700
Mailing Address - Country:US
Mailing Address - Phone:804-724-8144
Mailing Address - Fax:804-251-0562
Practice Address - Street 1:115 TEAL WAY
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3700
Practice Address - Country:US
Practice Address - Phone:804-724-8144
Practice Address - Fax:804-251-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health