1184649006 NPI number — BENDA HEALTHCARE, INC.

Table of content: (NPI 1184649006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184649006 NPI number — BENDA HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENDA HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184649006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1039 ISLINGTON ST STE 16
Provider Second Line Business Mailing Address:
FORMERLY 10 VAUGHAN MALL, SUITE 16
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-4262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-431-0505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1039 ISLINGTON ST UNIT 16
Provider Second Line Business Practice Location Address:
FORMERLY 10 VAUGHAN MALL, SUITE 16
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-431-0505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENDA
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-431-0505

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  02272 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30009054 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30009055 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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