Provider Demographics
NPI:1316710353
Name:BENJY-OSARENKHOE, OSASENAGA
Entity type:Individual
Prefix:
First Name:OSASENAGA
Middle Name:
Last Name:BENJY-OSARENKHOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 VIRGINIA ST E STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2154
Mailing Address - Country:US
Mailing Address - Phone:704-361-1999
Mailing Address - Fax:
Practice Address - Street 1:602 VIRGINIA ST E STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2154
Practice Address - Country:US
Practice Address - Phone:704-361-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator