Provider Demographics
NPI:1568197200
Name:AMERICAN BENISON CLEANING
Entity Type:Organization
Organization Name:AMERICAN BENISON CLEANING
Other - Org Name:AMERICAN BENISON CLEANING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHONTAE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-625-6300
Mailing Address - Street 1:13212 TERMINAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4814
Mailing Address - Country:US
Mailing Address - Phone:440-625-6300
Mailing Address - Fax:440-625-6301
Practice Address - Street 1:13212 TERMINAL AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-4814
Practice Address - Country:US
Practice Address - Phone:440-625-6300
Practice Address - Fax:440-625-6301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN BENISON CLEANING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH301228830Medicaid