Provider Demographics
NPI:1508450958
Name:BENROSE HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:BENROSE HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-518-1140
Mailing Address - Street 1:2105 PALATINE PL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9129
Mailing Address - Country:US
Mailing Address - Phone:404-518-1140
Mailing Address - Fax:404-973-3242
Practice Address - Street 1:2105 PALATINE PL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9129
Practice Address - Country:US
Practice Address - Phone:404-518-1140
Practice Address - Fax:404-973-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care