Provider Demographics
NPI:1669297669
Name:BENESHA HOME CARE LLC
Entity type:Organization
Organization Name:BENESHA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:BIBOMBE
Authorized Official - Last Name:MBUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-352-8964
Mailing Address - Street 1:26 ROLLINS WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1945
Mailing Address - Country:US
Mailing Address - Phone:207-352-8964
Mailing Address - Fax:
Practice Address - Street 1:26 ROLLINS WAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1945
Practice Address - Country:US
Practice Address - Phone:207-352-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care