MEDICARE: BENEVOLENCE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1578191730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVOLENCE HOME CARE LLC

Provider Business Mailing Address
First Line	:	3523 WOODRIDGE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1533
Country	:	US
Telephone Number	:	216-203-7387
Fax Number	:

Provider Business Practice Location Address
First Line	:	3523 WOODRIDGE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1533
Country	:	US
Telephone Number	:	216-203-7387
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. EBONY M EADDIE
Credential	:
Telephone Number	:	216-203-7387

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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