MEDICARE: BENEVOLENCE INDUSTRIES INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)	550001971	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578763207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVOLENCE INDUSTRIES INCORPORATED

Provider Business Mailing Address
First Line	:	1010 CRENSHAW BLVD STE 100
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2055
Country	:	US
Telephone Number	:	323-732-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 CRENSHAW BLVD
Second Line	:	109
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-732-0100
Fax Number	:	323-732-0104

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KWABENA OBENG
Credential	:
Telephone Number	:	310-800-7963

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	01/21/2021

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Directions to “BENEVOLENCE INDUSTRIES INCORPORATED ” Practice Location

Language	Start Address	Practice Location

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