Provider Demographics
NPI:1184649006
Name:BENDA HEALTHCARE, INC.
Entity Type:Organization
Organization Name:BENDA HEALTHCARE, INC.
Other - Org Name:BENDA HOMECARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-431-0505
Mailing Address - Street 1:1039 ISLINGTON ST STE 16
Mailing Address - Street 2:FORMERLY 10 VAUGHAN MALL, SUITE 16
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4262
Mailing Address - Country:US
Mailing Address - Phone:603-431-0505
Mailing Address - Fax:
Practice Address - Street 1:1039 ISLINGTON ST UNIT 16
Practice Address - Street 2:FORMERLY 10 VAUGHAN MALL, SUITE 16
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4262
Practice Address - Country:US
Practice Address - Phone:603-431-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02272251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009054Medicaid
NH30009055Medicaid
NH30009055Medicaid