Provider Demographics
NPI:1619413291
Name:RUDOLPH R. BENSON DBA GUARDIAN OF ANGELS
Entity Type:Organization
Organization Name:RUDOLPH R. BENSON DBA GUARDIAN OF ANGELS
Other - Org Name:GUARDIAN OF ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-341-4325
Mailing Address - Street 1:936 ROCK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2946
Mailing Address - Country:US
Mailing Address - Phone:800-341-4325
Mailing Address - Fax:800-341-4325
Practice Address - Street 1:936 ROCK CANYON DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2946
Practice Address - Country:US
Practice Address - Phone:800-341-4325
Practice Address - Fax:800-341-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage