Provider Demographics
NPI:1508498544
Name:BENARD & ROMULUS LLC
Entity Type:Organization
Organization Name:BENARD & ROMULUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ROMULUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-527-2521
Mailing Address - Street 1:917 REVERE WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5969
Mailing Address - Country:US
Mailing Address - Phone:770-527-2521
Mailing Address - Fax:
Practice Address - Street 1:917 REVERE WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-5969
Practice Address - Country:US
Practice Address - Phone:770-527-2521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1205107067Medicaid