Provider Demographics
NPI:1770243909
Name:BENTHERE HEALTHCARE
Entity Type:Organization
Organization Name:BENTHERE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:ABILA
Authorized Official - Middle Name:PRIMUS
Authorized Official - Last Name:BENAZEA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:781-521-0302
Mailing Address - Street 1:9 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1027
Mailing Address - Country:US
Mailing Address - Phone:781-521-0302
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 314H
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6112
Practice Address - Country:US
Practice Address - Phone:781-521-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care