Provider Demographics
NPI:1740916287
Name:BENAIAH HEALTHCARE LLC
Entity type:Organization
Organization Name:BENAIAH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMIGBADE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-474-8516
Mailing Address - Street 1:5896 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2312
Mailing Address - Country:US
Mailing Address - Phone:813-474-8516
Mailing Address - Fax:813-253-5301
Practice Address - Street 1:5896 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2312
Practice Address - Country:US
Practice Address - Phone:813-474-8516
Practice Address - Fax:813-253-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities