Provider Demographics
NPI:1558996850
Name:BENEFIT COMMUNITY SOURCE LLC
Entity Type:Organization
Organization Name:BENEFIT COMMUNITY SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS.
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-435-8829
Mailing Address - Street 1:550 N REO ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1037
Mailing Address - Country:US
Mailing Address - Phone:813-435-8829
Mailing Address - Fax:
Practice Address - Street 1:550 N REO ST STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1037
Practice Address - Country:US
Practice Address - Phone:813-435-8829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101283400Medicaid