Provider Demographics
NPI:1609521558
Name:BENEVOLENT HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:BENEVOLENT HEALTHCARE SERVICES, LLC
Other - Org Name:ERIKA M HARRIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RIDENOUR-WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-221-8587
Mailing Address - Street 1:2212 FLOWERDEW CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3190
Mailing Address - Country:US
Mailing Address - Phone:910-850-8636
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2310
Practice Address - Country:US
Practice Address - Phone:757-719-9039
Practice Address - Fax:866-432-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No171400000XOther Service ProvidersHealth & Wellness Coach
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144569435OtherPRACTIONER NPI
VA1144569435Medicaid