Provider Demographics
NPI:1396397618
Name:CHERYL BENEDETTO, LLC
Entity type:Organization
Organization Name:CHERYL BENEDETTO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-269-2988
Mailing Address - Street 1:5775 RED LEAF DR S APT 213
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3023
Mailing Address - Country:US
Mailing Address - Phone:505-269-2988
Mailing Address - Fax:
Practice Address - Street 1:5775 RED LEAF DR S APT 213
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-3023
Practice Address - Country:US
Practice Address - Phone:505-269-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)