Healthcare Provider Details

I. General information

NPI: 1669317814
Provider Name (Legal Business Name): BENEVOLENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 UNIVERSITY AVE W STE 109
SAINT PAUL MN
55104-3910
US

IV. Provider business mailing address

7825 IRISH AVE S
COTTAGE GROVE MN
55016-2073
US

V. Phone/Fax

Practice location:
  • Phone: 612-209-3149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CABDULHI MOHMED
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-209-3149