Healthcare Provider Details

I. General information

NPI: 1295641306
Provider Name (Legal Business Name): BENEVOLENT CARE WELLNESS & TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL
INDIANAPOLIS IN
46254-5620
US

IV. Provider business mailing address

6602 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2865
US

V. Phone/Fax

Practice location:
  • Phone: 317-712-6361
  • Fax:
Mailing address:
  • Phone: 317-712-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIGNON R HOLDER
Title or Position: OWNER
Credential:
Phone: 317-712-6361