MEDICARE: BENEVOLENCE COMMUNITY CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1871281469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVOLENCE COMMUNITY CARE LLC

Provider Business Mailing Address
First Line	:	3877 BAYAMON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6428
Country	:	US
Telephone Number	:	702-493-5998
Fax Number	:

Provider Business Practice Location Address
First Line	:	8685 W SAHARA AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5880
Country	:	US
Telephone Number	:	702-493-5998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAIGE KELLY
Credential	:
Telephone Number	:	702-493-5998

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	08/01/2024

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