Provider Demographics
NPI:1497166672
Name:BENEVOLENCE INDUSTRIES INCORPORATED
Entity Type:Organization
Organization Name:BENEVOLENCE INDUSTRIES INCORPORATED
Other - Org Name:BENEVOLENCE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
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 1:805 W LA VETA AVE
Mailing Address - Street 2:110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3901
Mailing Address - Country:US
Mailing Address - Phone:714-289-8800
Mailing Address - Fax:714-633-9928
Practice Address - Street 1:805 W LA VETA AVE
Practice Address - Street 2:110
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3901
Practice Address - Country:US
Practice Address - Phone:714-289-8800
Practice Address - Fax:714-633-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health