NPIMap

Organization Active NPI

Benevolence Industries Incorporated

Doing business as Benevolence Health Centers

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1457781676
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BENEVOLENCE INDUSTRIES INCORPORATED
Doing business as
Benevolence Health Centers
Practice address
611 E Imperial Hwy
Suite 107
Los Angeles, CA 90059-2358
Phone
(323) 732-0100
NPI assigned
Nov 25, 2013
Last updated
Jan 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kwabena Obeng
Title
President
Phone
(310) 800-7963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

611 E Imperial Hwy
Suite 107
Los Angeles, CA 90059-2358

Mailing address

1010 Crenshaw Blvd Ste 100
Torrance, CA 90501-2055
Phone (310) 617-5651

Other names 1

  • Benevolence Health Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070910000638 CA Part B Supplier - Clinic/Group Practice 3870686611 Receives reassigned benefits from 13 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sylmar, CA; Orange, CA; Los Angeles, CA; Long Beach, CA; Compton, CA; Anaheim, CA
O20210506002716 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870686611 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457781676. Details of each certification follow.

Federally qualified health center certification: CCN A01015

Legal name
BENEVOLENCE INDUSTRIES INCORPORATED
Doing business as
BENEVOLENCE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 16, 2021
Last certification
Jun 16, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 17, 2005 in CA
Enrollment address
611 E Imperial Hwy
Ste 107
Los Angeles, CA 90059-2359

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Benevolence Industries Incorporated13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3533 W Pico Blvd
Los Angeles, CA 90019
Phone (323) 732-6999

805 W La Veta Ave
Ste 110
Orange, CA 92868
Phone (714) 289-8800

12610 Glenoaks Blvd
Fl 1
Sylmar, CA 91342
Phone (818) 361-4111

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Fern Stamps Individual Corporate DirectorBoard Member May 5, 2014 100%
Benevolence Industries Incorporated Organization, Torrance, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 5, 2014 100%
Operational/Managerial Control May 5, 2014 100%
Ernestine Smith Individual Corporate DirectorBoard Chairperson May 5, 2014 100%
Kwabena Obeng Individual Corporate OfficerCeo May 5, 2014 100%
W-2 Managing EmployeeCeo May 5, 2014 100%
Operational/Managerial ControlCeo May 5, 2014 100%
Edward Frimpong Individual Corporate DirectorBoard Member May 5, 2014 100%
Frank Koomson Individual Corporate OfficerChief Operating Officer May 5, 2014 100%
W-2 Managing EmployeeChief Operating Officer May 5, 2014 100%
Operational/Managerial ControlChief Operating Officer May 5, 2014 100%
Rebekah Jennings Individual Corporate DirectorBoard Member May 5, 2014 100%
Emmanuel Freduah Agyemang Individual Corporate OfficerChief Financial Officer Aug 1, 2016 100%
W-2 Managing EmployeeChief Financial Officer Aug 1, 2016 100%
Operational/Managerial ControlChief Financial Officer Aug 1, 2016 100%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Benevolence Health CenterAnaheim, CA, CCN 921187 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 8, 2014
Jul 8, 2014
Benevolence Health CenterOrange, CA, CCN 921188 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 12, 2014
May 12, 2014
Benevolence Health CenterLong Beach, CA, CCN 921189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 3, 2014
Feb 3, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611187200000",
    "number": "1457781676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 CRENSHAW BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905012055",
            "telephone_number": "310-617-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E IMPERIAL HWY",
            "address_2": "SUITE 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900592358",
            "telephone_number": "323-732-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEVOLENCE INDUSTRIES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-25",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "OBENG",
        "authorized_official_first_name": "KWABENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-800-7963",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benevolence Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Benevolence Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.