Provider Demographics
NPI:1679609119
Name:ROBERT J. BENAVIDES
Entity type:Organization
Organization Name:ROBERT J. BENAVIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT FOSTER CARE
Authorized Official - Phone:210-522-9732
Mailing Address - Street 1:8502 CHIMNEYHILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2019
Mailing Address - Country:US
Mailing Address - Phone:210-522-9732
Mailing Address - Fax:
Practice Address - Street 1:8502 CHIMNEYHILL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2019
Practice Address - Country:US
Practice Address - Phone:210-522-9732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119321302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization