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General NPI Number Information
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NPI Number | 1184367146
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Entity Type | Organization
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Legal Business Name | BENEVOLENCE LLC
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 18 WOODLAKE DR SE
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City | ROCHESTER
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State | MN
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Zip | 55904-6250
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Country | US
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Telephone | 507-517-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 18 WOODLAKE DR SE
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City | ROCHESTER
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State | MN
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Zip | 55904-6250
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Country | US
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Telephone | 507-517-9142
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MOHAMUD AHMED
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Credential |
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Telephone | 507-517-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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