| Benevolence Llc | |
|
6113 Rome Cir Nw Rochester MN 55901-4846 | |
| (507) 517-9142 | |
| Not Available |
| Full Name | Benevolence Llc |
|---|---|
| Speciality | Early Intervention Provider Agency |
| Location | 6113 Rome Cir Nw, Rochester, Minnesota |
| Authorized Official Name and Position | Mohamud Ahmed (CEO) |
| Authorized Official Contact | 5075179142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benevolence Llc 1901 Desoto St Apt 215 Saint Paul MN 55117-2498 Ph: (507) 517-9142 | Benevolence Llc 6113 Rome Cir Nw Rochester MN 55901-4846 Ph: (507) 517-9142 |
| NPI Number | 1184367146 |
|---|---|
| Provider Enumeration Date | 04/18/2022 |
| Last Update Date | 07/25/2024 |
| Certification Date | 07/25/2024 |
| Medicare PECOS PAC ID | 0547638447 |
|---|---|
| Medicare Enrollment ID | O20221128001300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184367146 | NPI | - | NPPES |
| Provider Name | Jennifer R Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366743916 PECOS PAC ID: 5496930992 Enrollment ID: I20110427000331 |
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