Provider Demographics
NPI:1821469263
Name:BENEVOLENCE INDUSTRIES INCORPORATED
Entity Type:Organization
Organization Name:BENEVOLENCE INDUSTRIES INCORPORATED
Other - Org Name:BENEVOLENCE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-732-0100
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:424-558-8100
Practice Address - Street 1:920 N LONG BEACH BLVD
Practice Address - Street 2:1
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-2260
Practice Address - Country:US
Practice Address - Phone:323-732-0100
Practice Address - Fax:424-785-7390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEVOLENCE INDUSTRIES INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-12
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)