Provider Demographics
NPI:1730650169
Name:NGARAMBE, BENSON
Entity Type:Individual
Prefix:MR
First Name:BENSON
Middle Name:
Last Name:NGARAMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 ROLAND CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3461
Mailing Address - Country:US
Mailing Address - Phone:574-217-7101
Mailing Address - Fax:
Practice Address - Street 1:719 ROLAND CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3461
Practice Address - Country:US
Practice Address - Phone:574-217-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home