Individual
CARLISA BENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 PARKSIDE BLVD, TOLEDO, OH 43607-3765
(419) 690-4136
Mailing address
1211 PARKSIDE BLVD, TOLEDO, OH 43607-3765
(419) 690-4136
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
JCV7014
OH
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320187
—
OH
Enumeration date
12/01/2020
Last updated
03/17/2025
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