Provider Demographics
NPI:1518394451
Name:VENCER CARE, LLC
Entity Type:Organization
Organization Name:VENCER CARE, LLC
Other - Org Name:VENCER VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-881-0773
Mailing Address - Street 1:255 W SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1445
Mailing Address - Country:US
Mailing Address - Phone:201-881-0773
Mailing Address - Fax:201-881-0776
Practice Address - Street 1:255 W SPRING VALLEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1445
Practice Address - Country:US
Practice Address - Phone:201-881-0773
Practice Address - Fax:201-881-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00734800332B00000X, 332BP3500X, 3336H0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0463612Medicaid
NJ=========OtherTRICARE
NJ7222350001Medicare NSC