Provider Demographics
NPI:1235959628
Name:BENEVOLENT SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:BENEVOLENT SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MPH, QMHP
Authorized Official - Phone:757-629-3942
Mailing Address - Street 1:464 INVESTORS PL STE 206C
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1384
Mailing Address - Country:US
Mailing Address - Phone:757-629-3942
Mailing Address - Fax:757-716-9108
Practice Address - Street 1:464 INVESTORS PL STE 206C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1384
Practice Address - Country:US
Practice Address - Phone:757-629-3942
Practice Address - Fax:757-716-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services