Provider Demographics
NPI:1881902062
Name:ST. BENEDICT ASSISTED LIVING SERVICES, LLC
Entity type:Organization
Organization Name:ST. BENEDICT ASSISTED LIVING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:201-952-3616
Mailing Address - Street 1:482 BROADSTONE WAY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3516
Mailing Address - Country:US
Mailing Address - Phone:201-952-3616
Mailing Address - Fax:
Practice Address - Street 1:482 BROADSTONE WAY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3516
Practice Address - Country:US
Practice Address - Phone:201-952-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management