Provider Demographics
NPI:1104673508
Name:BENEVOLENCE INDUSTRIES INCORPORATED
Entity type:Organization
Organization Name:BENEVOLENCE INDUSTRIES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:GODFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DANQUAH
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:
Practice Address - Street 1:2621 S BRISTOL ST STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5718
Practice Address - Country:US
Practice Address - Phone:323-732-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEVOLENCE INDUSTRIES INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center