Provider Demographics
NPI:1578763207
Name:BENEVOLENCE INDUSTRIES INCORPORATED
Entity Type:Organization
Organization Name:BENEVOLENCE INDUSTRIES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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 1:1010 CRENSHAW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2055
Mailing Address - Country:US
Mailing Address - Phone:323-732-0100
Mailing Address - Fax:
Practice Address - Street 1:3631 CRENSHAW BLVD
Practice Address - Street 2:109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4869
Practice Address - Country:US
Practice Address - Phone:323-732-0100
Practice Address - Fax:323-732-0104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRENSHAW COMMUNITY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-20
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CA550001971261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578763207Medicaid
CA1578763207Medicaid