Healthcare Provider Details

I. General information

NPI: 1225485931
Provider Name (Legal Business Name): MICHELENE BENOIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 E CHELTEN AVE
PHILADELPHIA PA
19138-3014
US

IV. Provider business mailing address

2014 E CHELTEN AVE
PHILADELPHIA PA
19138-3014
US

V. Phone/Fax

Practice location:
  • Phone: 267-730-7990
  • Fax: 215-438-8850
Mailing address:
  • Phone: 267-730-7990
  • Fax: 215-438-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number9301849
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA175604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: