Provider Demographics
NPI:1598270852
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 STE 201
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1444
Mailing Address - Country:US
Mailing Address - Phone:888-554-9554
Mailing Address - Fax:201-881-0776
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 201
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:888-554-9554
Practice Address - Fax:201-881-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28RS00734800332BC3200X
NJ28RS00734800332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0463621Medicaid