Healthcare Provider Details

I. General information

NPI: 1770243909
Provider Name (Legal Business Name): BENTHERE HEALTHCARE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 314H
BEVERLY MA
01915-6112
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 314H
BEVERLY MA
01915-6112
US

V. Phone/Fax

Practice location:
  • Phone: 781-521-0302
  • Fax:
Mailing address:
  • Phone: 781-521-0302
  • Fax: 978-219-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABILA PRIMUS BENAZEA
Title or Position: DOCTOR OF NURSING PRACTICE
Credential: DNP
Phone: 781-521-0302