Provider Demographics
NPI:1346860731
Name:BENDICION DIVINA PERSONAL ASSISTANCE SERVICES, LLC
Entity Type:Organization
Organization Name:BENDICION DIVINA PERSONAL ASSISTANCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-572-9480
Mailing Address - Street 1:950 E. ALTON GLOOR BLVD.
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526
Mailing Address - Country:US
Mailing Address - Phone:956-572-9480
Mailing Address - Fax:956-621-0700
Practice Address - Street 1:950 E. ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-572-9480
Practice Address - Fax:956-621-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-25
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000Medicaid