Provider Demographics
NPI:1013289784
Name:COMPANION EXTRAORDINAIRE NURSING NETWORK
Entity Type:Organization
Organization Name:COMPANION EXTRAORDINAIRE NURSING NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENINGHOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-752-2205
Mailing Address - Street 1:112 ENGLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2083
Mailing Address - Country:US
Mailing Address - Phone:804-752-2205
Mailing Address - Fax:804-752-3403
Practice Address - Street 1:112 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2083
Practice Address - Country:US
Practice Address - Phone:804-752-2205
Practice Address - Fax:804-752-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0715000070251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0159264222Medicaid