Healthcare Provider Details

I. General information

NPI: 1609521558
Provider Name (Legal Business Name): BENEVOLENT HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 JAMESTOWN RD STE 101
WILLIAMSBURG VA
23185-2310
US

IV. Provider business mailing address

2212 FLOWERDEW CT
WILLIAMSBURG VA
23185-3190
US

V. Phone/Fax

Practice location:
  • Phone: 757-719-9039
  • Fax: 866-432-1706
Mailing address:
  • Phone: 910-850-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: PEGGY JANE RIDENOUR-WOLFE
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 859-221-8587