MEDICARE: BENEVOLENT CARE CENTERS, 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	253Z00000X	In Home Supportive Care Agency	RN-253537	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1810213	OTHER	OH	OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861715856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVOLENT CARE CENTERS, LLC

Provider Business Mailing Address
First Line	:	13508 MAPLEROW AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-6932
Country	:	US
Telephone Number	:	216-956-2419
Fax Number	:	216-662-2708

Provider Business Practice Location Address
First Line	:	13508 MAPLEROW AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-6932
Country	:	US
Telephone Number	:	216-956-2419
Fax Number	:	216-662-2708

Authorized Official
Title or Position	:	CEO
Name	:	BENITHA SEBRINA GARRETT
Credential	:	RN, BSN
Telephone Number	:	216-965-5040

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	03/05/2010

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