| Doctor Name: | BENSON IGBOELI |
| NPI Number: | 1003161274 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 000000000000 |
| Business Practice Address: | 829 Springwood Dr Grand Prairie, TX - 750526092 |
| Business Phone Number: | 9722625828 |
| Business Fax Number: | 9722625828 |
| Mailing Address: | 829 Springwood Dr, GRAND PRAIRIE |
| State: | TX |
| Postal Code: | 750526092 |
| Phone Number: | 9722625828 |
| Fax Number: | 9722625828 |
| NPI Enumeration Date: | 07/13/2012 |
| NPI Last Update Date: | 07/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251T00000X |
| License Number: | 000000000000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | PACE Provider Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |